Category Archives: Lung Transplantation

Effects of a Telephone-Based Psychosocial Intervention for Patients Awaiting Lung Transplantation: Summary

This study is limited by the small, self-selected sample, which may limit its generalizability. In addition, the sample included transplantation candidates who had different lung diseases. Although lung transplantation candidates share a condition with many common features (eg, all have severe lung disease and have a life expectancy of < 2 years), there may be distinct psychosocial issues facing patients with different lung diseases (ie, cystic fibrosis and COPD). These different pulmonary conditions may be associated with differences in quality of life and may present different psychological challenges, which may require distinct therapeutic approaches to be maximally effective. Another limitation was that the assessors were not blinded to treatment group. Although the psychological measures were self-administered and objectively scored, it is possible that patients in the treatment group may have biased their responses in a deliberate effort to present themselves as improved or perhaps more subtly to “please” the assessors.

Effects of a Telephone-Based Psychosocial Intervention for Patients Awaiting Lung Transplantation: Posttransplantation

Effects of a Telephone-Based Psychosocial Intervention for Patients Awaiting Lung Transplantation: PosttransplantationThe present findings may have important clinical implications for the care of patients awaiting lung transplantation. Because high levels of psychosocial distress may be associated with adverse health outcomes, posttransplant noncompliance and poor posttransplant psychological adjustment, reducing anxiety and improving psychosocial well-being before the patient undergoes transplantation, may improve clinical outcomes. The effect sizes ranged from 0.31 to 1.25, with a median of 0.41, suggesting that the treatment group on average scored about 0.4 SD higher than the control group on the outcome measures. This is typically considered to be a moderate effect size in the behavioral sciences and certainly would be clinically significant. We are currently examining the impact of a more extensive telephone-based intervention on psychosocial functioning and clinical end points such as compliance, rehospitalization, and survival in pretransplant candidates.

Effects of a Telephone-Based Psychosocial Intervention for Patients Awaiting Lung Transplantation: Discussion

Social Support: After controlling for pretreatment social support, age, gender, and time spent waiting on the transplant list, the ANCOVA revealed a significant treatment group effect for the general social support scale (F [1,70] = 6.88; p < 0.01). Although there were no treatment group differences in perceived social support at baseline, participants in the SI condition perceived more support from the people in their lives when compared with individuals in the control group at the end of the 8-week program. Patients in the SI condition increased their perceived support, while patients in the UC condition exhibited a slight decline in perceived support (Fig 2).

Effects of a Telephone-Based Psychosocial Intervention for Patients Awaiting Lung Transplantation: Dropout and Compliance

Effects of a Telephone-Based Psychosocial Intervention for Patients Awaiting Lung Transplantation: Dropout and ComplianceAmong the 35 patients who entered the UC condition with compete baseline assessments, 3 were unable to complete the follow-up assessments (1 patient was rehospitalized and was too sick to complete the posttreatment measures, 1 patient moved from her original address and did not provide an updated address or telephone number, and 1 patient did not return materials). All of the 36 patients who were entered the SI condition with compete baseline assessment data received the full eight sessions, but 2 patients received a transplant before they could complete the follow-up assessment (Fig 1).
Treatment Group Differences
GHQ: A MANCOVA on the GHQ subscales revealed a significant treatment-group effect multivariate (F [4,66] = 3.36; p < 0.05). Table 2 presents group GHQ means and SDs before and after treatment, with higher scores reflecting better functioning. Univariate analyses of covariance (ANCOVAs) revealed that, compared to individuals in the UC group, those in the SI group reported less general distress, anxiety, social dysfunction, depression, and fewer somatic symptoms.

Effects of a Telephone-Based Psychosocial Intervention for Patients Awaiting Lung Transplantation: UC Control Condition

UC Control Condition: Participants in the UC control group received their UC through the transplant service at Duke University Medical Center. This UC included clinic visits with the pulmonologists and nurse coordinators, and regular contact with the nurse coordinators. Members of the transplant team were blinded to patient group assignments. Patients in the SI condition also received UC, so the SI intervention provided additional counseling over and above UC. Clinic visits are routinely scheduled every 3 to 6 months, as clinically indicated. There were no scheduled visits during the 8-week intervention period.
Statistical Analysis
The primary data analysis strategy was to conduct separate multivariate analysis of covariance (MANCOVA) models on the general well-being (ie, GHQ), health-related quality of life (ie, SF-36 and PQLS), perceived stress, and social support subscales.

Effects of a Telephone-Based Psychosocial Intervention for Patients Awaiting Lung Transplantation: SI Condition

Effects of a Telephone-Based Psychosocial Intervention for Patients Awaiting Lung Transplantation: SI Condition4. Perceived social support related to transplantation. This scale also was designed for the present study (Appendix 3) in order to assess the extent to which individuals feel supported by the people in their lives (ie, family, friends, and transplant team members). Items include “How supported do you feel by your pulmonologist?” and “How supported do you feel by your family?” Higher scores reflect greater perceived support.
5. Perceived stress related to transplantation. This scale is based on research by Jalowiec and colleagues, which identified the primary stressors reported by patients waiting for a heart transplantation. Items are rated on a 4-point scale (0, not at all stressful; 3, very stressful). Sample items include the following: having end-stage lung disease; waiting for a donor to be found; and having one’s family take over responsibilities. Higher scores indicate greater distress.

Effects of a Telephone-Based Psychosocial Intervention for Patients Awaiting Lung Transplantation: PQLS

2. General health questionnaire (GHQ)., The GHQ is a 60-item scale that was developed to help primary care physicians screen for nonpsychotic psychiatric disorders. The four subscales of the GHQ are as follows: (1) somatic symptoms (eg, Have you been getting a feeling of tightness or pressure in your head?); (2) anxiety and insomnia (eg, Have you lost much sleep over worry?); (3) social dysfunction (eg, Have you been managing to keep yourself busy and occupied?); and (4) depression (eg, Have you felt that life is entirely hopeless?). The GHQ has been used to document the effectiveness of stress management interventions for cardiac patients and has been shown to be sensitive to changes in stress levels. Higher scores indicate more stress.
3. Pulmonary-specific quality-of-life scale (PQLS). This disease-specific quality-of-life measure (see “Appendix 2”) was developed specifically for use in the present study. Items were developed through focus groups and one-on-one interviews with pulmonary patients.

Effects of a Telephone-Based Psychosocial Intervention for Patients Awaiting Lung Transplantation: Procedure

Effects of a Telephone-Based Psychosocial Intervention for Patients Awaiting Lung Transplantation: ProcedureFollowing contact by mail, each lung transplantation candidate was contacted individually by telephone to describe the study. Patients were contacted in the order that they were listed on the Duke University transplant list. Once patients agreed to participate in the study and completed the baseline psychosocial evaluation (described below), they were randomly assigned either to a special intervention (SI; n = 36) or to usual care (UC; n = 35) [Fig 1].
Psychosocial Assessment: A battery of psychometric instruments was administered individually, by mail, to each patient before and after the 8-week intervention. The measures included the following:
1. Medical outcomes survey, short form-36 (SF-36).

Effects of a Telephone-Based Psychosocial Intervention for Patients Awaiting Lung Transplantation: Materials and Methods

It has been demonstrated that psychosocial interventions can enhance coping skills and improve quality of life and well-being in patients with chronic medical conditions such as HIV/AIDS,” cancer, and heart disease. The use of telephone-based interventions has gained increased attention as a viable alternative to conventional counseling. Because patients awaiting lung transplantation frequently live far from major medical centers and often do not have access to mental health services that are familiar with the unique issues facing transplant recipients, a telephone intervention provided by trained clinicians represents a practical and novel approach to improve well-being among patients listed for lung transplantation. The purpose of the present study, therefore, was to examine the efficacy of a telephone-based psychosocial intervention in reducing distress and improving health-related quality of life in patients awaiting lung transplantation.

Effects of a Telephone-Based Psychosocial Intervention for Patients Awaiting Lung Transplantation

Effects of a Telephone-Based Psychosocial Intervention for Patients Awaiting Lung TransplantationLung transplantation now represents a viable therapeutic option for many patients with advanced pulmonary parenchymal or pulmonary vascular diseases. Despite the relatively recent introduction of this procedure, successful shortterm outcomes are reported at most centers, with 1-year survival rates approaching 80%. Long-term outcomes remain disappointing, however, with 5-year survival rates of only approximately 50%.