title: Development and preliminary evaluation of a telephone-based coping skills training intervention for survivors of acute lung injury and their informal caregivers.
abstract: OBJECTIVE
  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.
authors.affiliation: Duke University Medical Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University, Box 102043, Durham, NC 27710, USA. christopher.cox@duke.edu
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Cox
authors.forename: Laura S
authors.initials: LS
authors.lastname: Porter
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Hough
authors.forename: Douglas B
authors.initials: DB
authors.lastname: White
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Kahn
authors.forename: Shannon S
authors.initials: SS
authors.lastname: Carson
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Keefe
mesh_terms: D055371:Acute Lung Injury / Q000523:psychology*; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D003376:Counseling; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013315:Stress, Psychological / Q000209:etiology / Q000628:therapy*; D017741:Survivors / Q000523:psychology; D013689:Telephone