title: Impact of a disease-management program on symptom burden and health-related quality of life in patients with idiopathic pulmonary fibrosis and their care partners.
abstract: BACKGROUND
  Patients were recruited from the Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, located within the University of Pittsburgh Medical Center. Idiopathic pulmonary fibrosis results in scarring of the lung and respiratory failure, and has a median survival of 3 to 5 years from the time of diagnosis. The purpose of this study was to determine whether patients with idiopathic pulmonary fibrosis and their care partners could be more optimally managed by a disease-management intervention entitled "Program to Reduce Idiopathic Pulmonary Fibrosis Symptoms and Improve Management," which nurses delivered using the format of a support group. We hypothesized that participation would improve perceptions of health-related quality of life (HRQoL) and decrease symptom burden.
  
  
  METHODS
  Subjects were 42 participants randomized to an experimental (10 patient/care partner dyads) or control (11 patient/care partner dyads) group. Experimental group participants attended the 6-week program, and controls received usual care. Before and after the program, all participants completed questionnaires designed to assess symptom burden and HRQoL. Patients and care partners in the intervention group were also interviewed in their home to elicit information on their experience after participating in the Program to Reduce Idiopathic Pulmonary Fibrosis Symptoms and Improve Management.
  
  
  RESULTS
  After the intervention, experimental group patients rated their HRQoL less positively (P = .038) and tended to report more anxiety (P = .077) compared with controls. Care partners rated their stress at a lower level (P = .018) compared with controls. Course evaluations were uniformly positive. Post-study qualitative interviews with experimental group participants suggested benefits not exemplified by these scores. Patient participants felt less isolated, were able to put their disease into perspective, and valued participating in research and helping others.
  
  
  CONCLUSIONS
  Further exploration of the impact of disease-management interventions in patients with advanced lung disease and their care partners is needed using both qualitative and quantitative methodology. Disease-management interventions have the potential to positively affect patients with advanced lung disease and their care partners.
authors.affiliation: Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, Pulmonary Allergy and Critical Care Medicine Division, University of Pittsburgh, Pennsylvania, USA. lindellko@upmc.edu <lindellko@upmc.edu>
authors.forename: Kathleen Oare
authors.initials: KO
authors.lastname: Lindell
authors.forename: Ellen
authors.initials: E
authors.lastname: Olshansky
authors.forename: Mi-Kyung
authors.initials: MK
authors.lastname: Song
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Zullo
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Gibson
authors.forename: Naftali
authors.initials: N
authors.lastname: Kaminski
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Hoffman
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000704:Analysis of Variance; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D017028:Caregivers / Q000523:psychology*; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000188:drug therapy* / Q000401:mortality / Q000451:nursing; D008297:Male; D010865:Pilot Projects; D011594:Psychometrics; D011788:Quality of Life; D012129:Respiratory Function Tests; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D014481:United States