Exacerbations of Chronic Obstructive Pulmonary Disease (COPD) lead to roughly 1.5 million ED visits and
700,000 hospitalizations annually. Recovery is slow, and accompanied by high levels of acute care utilization
and mortality. Pulmonary Rehabilitation (PR) is a structured program of exercise and self-management support
that has been shown to relieve dyspnea and improve quality of life. Clinical guidelines recommend PR for
patients with stable COPD and after an exacerbation. Unfortunately, even when referred by physicians, our
research has shown that few patients who might benefit from PR ever begin treatment. The primary goal of this
project is to identify effective strategies for promoting and sustaining participation in PR.
Peer Support involves pairing a patient with a trained peer from a similar background, and facing similar
health challenges, who has completed PR. There is a growing body of evidence demonstrating the feasibility,
acceptability, and effectiveness of telephonic peer support for chronic disease management. Narrative
interventions, or `Storytelling', are novel approaches for changing attitudes and behaviors of patients that
involve creating and disseminating videos narrated by individuals with lived experience with the same condition
or facing the same treatment. Storytelling interventions have been shown to help patients achieve better blood
pressure control, and storytelling is being studied in a variety of other clinical contexts.
In the R61 Phase, we will recruit and train a cohort of peer coaches in behavior change techniques, and will
recruit a diverse group of storytellers, capture their narratives on video, and create a library of 6-8 powerful
stories. We will finalize our protocol, trial infrastructure, and pilot our recruitment strategy. During the R33
Phase, we will recruit 305 adults treated for exacerbation of COPD, and randomize them to 1) Enhanced
“Usual Care” (eUC); 2) eUC + Storytelling; or 3) eUC + Peer Support. We will evaluate the effectiveness of
each strategy compared to eUC, and to each other, at promoting participation in PR at 6 months. Using a
mixed-methods approach, we will evaluate intervention acceptability, sustainability, and cost, from the
perspectives of the patients and peer coaches as well as PR program staff and hospital leadership. We will use
these findings to refine the strategies and to disseminate an implementation package that will enable other PR
programs to adopt these approaches.
This project engages key stakeholders in study conceptualization, execution, and dissemination, and is
responsive to the NHLBI/CDC COPD National Action Plan that calls for the development of strategies to
increase the number of Americans that benefit from PR.