Development and preliminary evaluation of a telephone-based coping skills training intervention for survivors of acute lung injury and their informal caregivers

Abstract

Purpose: Survivors of acute lung injury (ALI) and their informal caregivers have difficulty coping with the physical and emotional challenges of recovery from critical illness. We aimed to develop and pilot test a telephone-based coping skills training intervention for this population.

Methods: Fifty-eight participants were enrolled overall. A total of 21 patients and 23 caregivers participated in a cross-sectional study to assess coping and its association with psychological distress. This also informed the development of an ALI coping skills training intervention in an iterative process involving content and methodological experts. The intervention was then evaluated in seven patients and seven caregivers in an uncontrolled, prospective, pre-post study. Outcomes included acceptability, feasibility, and symptoms of psychological distress measured with the Hospital Anxiety and Depression Scale (HADS) and Post-Traumatic Symptom Scale (PTSS).

Results: Survivors and their caregivers used adaptive coping infrequently, a pattern that was strongly associated with psychological distress. These findings informed the development of a 12-session intervention for acquiring, applying, and maintaining coping skills. In the evaluation phase, participants completed 77 (92 %) of a possible 84 telephone sessions and all (100 %) reported the intervention's usefulness in their daily routine. Mean change scores reflecting improvements in the HADS (7.8 U) and PTSS (10.3 U) were associated with adaptive coping (r = 0.50-0.70) and high self-efficacy (r = 0.67-0.79).

Conclusions: A novel telephone-based coping skills training intervention was acceptable, feasible, and may have been associated with a reduction in psychological distress among survivors of ALI and their informal caregivers. A randomized trial is needed to evaluate the intervention.

Figure 1. Study overview

This study consisted of two components, a development phase and an evaluation phase. The development consisted of an assessment of the relationship between psychological distress and coping, as well as the derivation of a coping skills training intervention. The prospective evaluation used an uncontrolled, pre-post intervention design to assess the intervention’s feasibility, acceptability, and clinical impact using validated measures of psychological distress. HADS=Hospital Anxiety and Depression Scale, PTSS=Post-Traumatic Symptom Scale, COPE=Brief COPE scale.

Figure 2. Preliminary results of pilot prospective evaluation of the coping skills training intervention

In this figure, both pre-intervention (dark bars) and post-intervention (light bars) scores for the HADS (total score as well as anxiety and depression domain scores) and PTSS questionnaires are shown for patients (n=7) and their informal caregivers (n=7).