Trying a Long-Distance Approach to Reducing Stress for Lung Transplant Patients
DURHAM, N.C. - Researchers at Duke University Medical Center believe they can improve the outcomes for lung transplant patients through a systematic program of stress and anxiety reduction before the operation.
What makes this trial novel, the researchers say, is that their approach will be by telephone, since many lung transplantation patients live at a distance from their transplant center and do not relocate until they move toward the top of the waiting list. Other patients are physically unable to make frequent trips outside the home for counseling.
On average, lung patients nationwide can remain on the waiting list for up to two years until a suitable organ becomes available.
The National Heart, Lung and Blood Institute, part of the National Institutes of Health, have awarded the research group, led by Duke psychologist James Blumenthal, a $2.6 million grant to support the study.
During the course of the four-year trial, researchers plan to enroll 600 patients awaiting transplants from Duke and from Barnes-Jewish Hospital at Washington University in St. Louis. In calendar year 1999, Duke performed 52 lung transplants, while Barnes-Jewish performed 47, making the institutions the largest in terms of number of procedures performed in the United States.
"Waiting for that call from the hospital saying that a life-saving organ is available can be an incredibly stressful time, so anything we can do to lower anxiety levels could benefit our patients," said Duke pulmonologist Dr. Scott Palmer, medical director of Duke's lung transplant program and one of the study's co-investigators. "The key question is whether or not there is any benefit after the transplant."
In addition to following how patients fare before and after the trial, the researchers will also be collecting data to see if the stress-management strategy can reduce the costs of lung transplantation.
Before lung patients can be placed on the national waiting list, transplant teams typically conduct thorough medical examinations to demonstrate first that the patient would benefit from the surgery, and then to ensure that he or she would be able to survive the operation. Additionally, patients receive a psychological screening to ensure they can adhere to the life-long schedule of medications necessary to keep the new lungs from being rejected by the immune system.
For the trial, patients who have been officially placed on the waiting list will be divided into two groups - one group will receive all the medical services and treatment currently provided by Duke or Barnes-Jewish, while the other half will also receive the weekly telephone counseling sessions.
"Counselors will be contacting patients weekly by telephone to help them lower their levels of anxiety and stress," Blumenthal said. "We believe that not only can stress reduction improve these patients' abilities to deal with the incredible stresses of living with debilitating lung diseases, but can also have a beneficial impact on how they do after the transplant operation."
All patients involved in the trial will be followed up at discharge from the hospital and annually thereafter.
"Our hope is that through these psychological interventions, we can demonstrate an improvement in our patients' quality of life, especially how they breathe and how they feel about their disease," Palmer said. "Stress and anxiety can play an important role in respiration - highly emotional events or situations can trigger symptoms that can in some cases even lead to hospitalization.
"Waiting can be the most stressful time imaginable," Palmer continued. "They worry about when the call from us might come, or if it will come at all. I can't imagine a more stressful situation to be in."
While the researchers say that very little data exist on the role of stress reduction in outcomes after transplantation, they say the anecdotal evidence gives them hope.
"It's been our experience that patients who are mentally prepared and have a good attitude going into their transplant tend to do much better after their transplants," said Dr. Duane Davis, surgical director of Duke's lung transplant program. "There seems to be a very strong mind-body link in how lung transplant patients do.
"Ideally, we'd like to show that this low-cost long-distance intervention will have a significant impact on how well our patients do before and after transplantation," Davis added.
In addition to seeing if the interventions improve overall outcomes, the researchers will also see how patients with different diseases are affected. The most common underlying disorders requiring transplantation are cystic fibrosis, pulmonary hypertension and chronic obstructive pulmonary disease.