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Devito Dabbs, A.
07/01/04-06/30/06
CRDF
Customized Hand Held Computer Applications
for Lung Transplant Recipients
Survival rates are lower, and there is a higher incidence
of acute complications after lung transplantation compared
to other organ transplants. Therefore, prevention of complications
requires a life-long commitment on behalf of lung transplant
recipients (LTR) to medication taking, self-monitoring for
complications, communicating changes to the transplant team,
and returning for regular follow-up evaluations.
Prior research
conducted revealed that because of the dramatic
improvements in health that patients experience as a consequence
of their transplant, LTR often disregard provider teaching
regarding the need to self-monitor and, instead, have naïve
expectations for normalcy. Findings also suggested that, overtime,
some LTR reconcile their unrealistic expectations for normalcy
after transplant, and trade them for 'normalcy within illness.'
At this point, they exhibit understanding of the need to become
an active partner with the transplant team in managing their
care.
The goal of the present study is to design an interactive
health technology (IHT) to decrease the time frame required
for LTR to reach this insight and, thereby, improve patient
outcomes through more prompt detection and reporting of acute
complications. Using an interactive process and based on principles
of user-centered deign, a prototype of the IHT partnering
intervention (customized interactive programs for the Hewlett
Packard iPaq hand held computer), will be designed and evaluated
for functionality (ergonomics, human computer interaction
factors, and usability) in a controlled setting with a small
sample of LTR who are within 12 months after transplant.
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Devito Dabbs,
A.
2005-2006
CRE
Pilot Study
Pocket Path: Using Pocket PCs to Promote After Transplant
Health
Lung transplant recipients have more complications, higher
mortality, and greater average healthcare charges than
recipients of other organs. Strategies to maximize active
recipient involvement in improving health outcomes have received
little attention. The proposed study will test a novel
intervention called Pocket Path: Using Pocket PCs to Promote
After Transplant Health in the field with 10 target users:
recipients of lung transplantation. The proposed intervention
provides lung transplant recipients a pocket PC with customized
data recording, tracking, messaging and decision-support
programs to promote their self-care behaviors, including:
performing self-monitoring, adhering to medical regimens, and
communicating changes to the transplant team.
The specific aims
of this prospective, on-group, open trial are to evaluate the
feasibility and recipients’ use of the Pocket Path
Intervention in recipients’ homes during the most crucial
period for developing self-care behaviors: the first two months
at home after the transplant procedure. Subjects will use
Pocket Path and its custom programs for 8 weeks, participate
in 5 intensive early phone assessments at 1,2,3,4 and 6 weeks
post-transplant, and one face-to-face interview session at 8
weeks post-transplant. The research material obtained from
subjects during the trial will include an intense assessment of
usage and satisfaction with the intervention in order to guide
refinement of the intervention. Because some subjects may come
to rely on the Pocket Path device and its custom programs
during the trial, it was deemed unethical to insist that they
return the device. Therefore, upon completion of the study,
subjects will be permitted to keep the personal PC and the
custom programs for their own use if they so desire.
This study builds on work related to prototype design and
testing for the Pocket Path Intervention that is
currently underway and expected to be complete by September
2005. The proposed study is therefore, the logical next step in
the development and testing of this new intervention.
Enrollment is expected to begin in October 2005. The results of
this feasibility, usage and satisfaction study will lead
directly to a pilot study to test the effectiveness and further
evaluate the safety of the Pocket Path Intervention
versus standard care on self-care behaviors and health
outcomes. The findings from these preliminary studies will lead
directly to an R01 for a full-scale, randomized clinical trial
to rigorously test the efficacy of the Pocket Path
Intervention for promoting self-care and improving health
outcomes (morbidity, mortality and health resource utilization)
after lung transplantation.
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De Vito Dabbs,
A.
08/23/05-07/31/08
K01
NR009385-01 NIH
Promoting Self-Care After Lung
Transplantation
Lung transplant recipients have more complications, higher
mortality than recipients of other organs, yet strategies to
maximize recipient involvement in improving health outcomes have
received little attention. This plan proposes a novel
intervention using a hand-held, interactive technology to
promote self-care agency and self-care behaviors in lung
recipients, thus maximizing the contribution of recipients
themselves in preventing and detecting post-transplant
complications.
The specific aims of the proposed project are to: 1) develop a
prototype of a self-care intervention and evaluate its
functionality and feasibility, and 2) pilot test the self-care
intervention using a randomized control design to estimate its
effects on self-care agency, self-care behaviors and health
outcomes compared to standard care after lung transplantation.
The work will culminate in development of a full-scale RCT to
evaluate its effectiveness in promoting recipients’ self-care
agency and self-care behaviors, thereby reducing
post-transplantation morbidity, mortality, and health-resource
utilization. A multidisciplinary mentoring team has been
developed for the principal investigator to gain expertise in:
1) the application of conceptual models to guide the development
of behavioral and psychosocial interventions, 2) the design and
conduct of clinical trials in transplant cohorts, and 3) using
and evaluating interactive technologies for portion of health.
These skills will assist in achieving long-term objectives of
becoming and independent nurse scientist and leading a
multidisciplinary research team to improve health outcomes for
lung transplant recipients and patients with other chronic
pulmonary conditions.
This proposal is designed to test whether providing lung
recipients with a pocket computer and custom programs to monitor
their conditions, take medications, and communicate with the
transplant team, will help prevent and detect the acute
complications that interfere with the quality of survival after
lung transplantation. The work has relevance for promoting
self-care activities for patients with a variety of chronic
conditions.
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