Anxiety Clinical Trial
Official title:
Efficacy of a Minimal Homebased Psychoeducative Intervention Versus Usual Care for the Management of Anxiety and Dyspnea in Patients With Severe Chronic Obstructive Pulmonary Disease
The purpose of this trial is to determine whether a minimal homebased psychoeducative intervention is effective in management of anxiety and dyspnea in patients with severe chronic obstructive pulmonary disease.
In patients with severe chronic obstructive pulmonary disease (COPD) anxiety and dyspnea are
described as the primary symptoms with a high impact on the patients quality of life and use
of social services. Both pharmacological and non-pharmacological strategies aimed at
reducing anxiety in patients with severe illness are challenged by low compliance and/or
side-effect, which emphasized the need of focusing on treatment strategies that addresses
the issues characteristic for a population with severe pulmonary disease.
The trial is a single-centre randomised clinical trial that test the hypothesis that a
minimal homebased psychoeducative intervention reduces anxiety in patients with severe COPD.
The primary outcome is anxiety assessed by the hospital and anxiety and depression scale
(HADS), subscale for anxiety (HADS-A). Secondary outcomes are mastery of dyspnea measured by
the Chronic Respiratory Questionnaire (CRQ), Health-related Quality of Life (HRQL) measured
by the St. George Respiratory Questionnaire (SGRQ) and depression measured by the HADS,
subscale for depression (HADS-D). The outcomes will be assessed at follow-up four weeks and
three months after the intervention.
The trial population consist of patients with severe COPD affiliated the Department of
Pulmonary & Infectious Diseases at Nordsjællands Hospital. Based on a sample size
calculation sixty-six patients with severe COPD and associated anxiety will be randomised
1:1 to either intervention plus usual care or to usual care.
The intervention consist of a minimal psychoeducative dialogue delivered in the patient's
home follow by a telephone booster session after two weeks. The intervention is based on a
manual, where the theoretical foundation is cognitive behavior theory. The intervention is
carried out by a nurse.
Our primary outcome of interest is intra-individual differences in HADS-A scores between
baseline and last follow-up after three months. To analyse this with-in group difference in
outcome we use paired t-test or Wilcoxon signed-rank. Differences between the groups will
similarly be assessed with two-sample t-test or Wilcoxon rank-sum test. Same strategy will
be used analyzing the secondary outcomes CRQ, SGRQ and HADS-D.
To include all points of follow-up and to evaluate the development with-in group and between
groups we use a longitudinal regression model. Because of an expected high number of drop
outs, the censuring due to death and missing data due to possibly lost to follow up will be
handled appropriately, under supervision and in collaboration with an experienced
bio-statistician. The sample size calculation is based on HADS-A, a paired design and a
estimated drop-out of 33.3 %.
The trial is designed with the aim of giving nurses and other health professionals an
instrument clinically applicable in proving care for patients with severe COPD and
associated anxiety. Positive or negative results of the trial will be submitted to
international journals.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Supportive Care
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