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.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL065503-03
Application #
6527411
Study Section
Special Emphasis Panel (ZRG1-RPHB-4 (05))
Program Officer
Czajkowski, Susan
Project Start
2000-09-30
Project End
2004-08-31
Budget Start
2002-09-01
Budget End
2003-08-31
Support Year
3
Fiscal Year
2002
Total Cost
$646,012
Indirect Cost
Name
Duke University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
071723621
City
Durham
State
NC
Country
United States
Zip Code
27705
Smith, P J; Blumenthal, J A; Hoffman, B M et al. (2018) Postoperative cognitive dysfunction and mortality following lung transplantation. Am J Transplant 18:696-703
Blumenthal, James A; Smith, Patrick J; Durheim, Michael et al. (2016) Biobehavioral Prognostic Factors in Chronic Obstructive Pulmonary Disease: Results From the INSPIRE-II Trial. Psychosom Med 78:153-62
Smith, Patrick J; Blumenthal, James A; Hoffman, Benson M et al. (2016) Reduced Cerebral Perfusion Pressure during Lung Transplant Surgery Is Associated with Risk, Duration, and Severity of Postoperative Delirium. Ann Am Thorac Soc 13:180-7
Smith, P J; Blumenthal, J A; Trulock, E P et al. (2016) Psychosocial Predictors of Mortality Following Lung Transplantation. Am J Transplant 16:271-7
Hoffman, Benson M; Stonerock, Gregory L; Smith, Patrick J et al. (2015) Development and psychometric properties of the Pulmonary-specific Quality-of-Life Scale in lung transplant patients. J Heart Lung Transplant 34:1058-65
Smith, P J; Rivelli, S K; Waters, A M et al. (2015) Delirium affects length of hospital stay after lung transplantation. J Crit Care 30:126-9
Durheim, Michael T; Smith, Patrick J; Babyak, Michael A et al. (2015) Six-minute-walk distance and accelerometry predict outcomes in chronic obstructive pulmonary disease independent of Global Initiative for Chronic Obstructive Lung Disease 2011 Group. Ann Am Thorac Soc 12:349-56
Smith, Patrick J; Rivelli, Sara; Waters, Alexa et al. (2014) Neurocognitive changes after lung transplantation. Ann Am Thorac Soc 11:1520-7
Blumenthal, James A; Emery, Charles F; Smith, Patrick J et al. (2014) The effects of a telehealth coping skills intervention on outcomes in chronic obstructive pulmonary disease: primary results from the INSPIRE-II study. Psychosom Med 76:581-92
Smith, Patrick J; Blumenthal, James A; Carney, Robert M et al. (2014) Neurobehavioral functioning and survival following lung transplantation. Chest 145:604-611

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