Lung transplantation is a relatively new procedure developed to increase life expectancy in selected individuals with irreversible end-stage lung disease. In the brief period since its inception, it appears that lung transplantation has achieved its initial aim of extending life. Despite these successes, lung transplantation remains fraught with difficult challenges for the patient and the medical community. The pre-surgical waiting period is a particularly stressful time. The long, uncertain wait for an organ, the marked decline in functional capacity, the tremendous financial burden, and the prospect of a complicated medical regimen after surgery, combine to exert a profound strain on patients' coping capacities. Not surprisingly, the rate of clinically significant psychological distress during this period is quite high, with rates of clinical depression, panic, anxiety and adjustment disorders far exceeding those observed in the general population. Although it is well established that brief, focused cognitive-behavioral therapy (CBT) can significantly improve psychological function in medically ill persons, the wide geographic distribution of transplant patients, along with their marked debilitation makes face-to-face delivery of such therapy extremely difficult. Recent pilot data have demonstrated the feasibility and short-term efficacy of a telephone-based psychological intervention with patients awaiting transplant. A larger, dual-site (Duke and Washington University), randomized trial using a relatively comprehensive set of outcome measures, over an extended follow-up period is proposed in which 600 pre-surgical lung transplant patients will be randomly assigned to either a telephone-based CBT intervention or to usual care. The study will examine the short- and longer-term impact of the intervention on psychological distress and quality of life as well as the effects of the intervention on morbidity, mortality, and medical costs during the pre- and post-operative periods. If the intervention is successful, it may serve as a model for the delivery of home-based, cost-effective treatment for seriously ill patients unable to benefit from more traditional face-to-face psychotherapy.
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