Aronson Kerri I, Holbrook Nancy, Edgar Armani, Anderson Michaela R, Krishnan Jamuna K, Kaner Robert J, Podolanczuk Anna J, Martinez Fernando J, Tobin Johnathan N, Safford Monika M
Division of Pulmonary and Critical Care, Weill Cornell Medicine, New York, NY, United States.
Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States.
CHEST Pulm. 2024 Dec;2(4). doi: 10.1016/j.chpulm.2024.100083. Epub 2024 Jul 6.
Behavioral and educational interventions are promising approaches to improve health-related quality of life (HRQOL), however few have been studied in Hypersensitivity Pneumonitis (HP) or other interstitial lung diseases (ILD). The objective of this study was to gather ILD clinicians' current practices and perspectives on the management of HRQOL and disease-specific education in HP, knowledge and attitudes about behavioral and educational interventions, and identify potential clinician perceived barriers to address during intervention development.
An electronic survey was administered to ILD clinicians across the United States. Survey data were analyzed using descriptive statistics and open-ended questions were analyzed using qualitative content analysis.
74 clinicians responded to the survey, of whom 93% identified as physicians. All respondents (100%) indicated that offering an intervention to improve HRQOL in their patients with HP is either very important, or absolutely essential. Only 5% of clinicians reported currently using a validated assessment tool to measure HRQOL. When asked about specific behavioral intervention techniques, most clinicians (92%) reported possessing a small amount, or zero knowledge about peer coaching interventions, and a small amount or zero knowledge (69%) about cognitive behavioral therapy (CBT) principles. Despite this, a majority (68%) of clinicians desire the ability to educate their patients about these potentially effective behavioral interventions, and a majority (67%) of clinicians indicated the desire to reinforce the principles of an intervention after completion. Perceived barriers to referring patients to a virtually delivered behavioral intervention included time constraints, availability and access for all patients, cost and reimbursement, and difficulty with technology.
Clinicians in this survey unanimously agree that interventions to improve HRQOL and knowledge are needed for people living with HP. Clinicians' desire for involvement in education, referral and reinforcement of these interventions will require clinician education in behavioral strategies and implementation-related strategies early in the development process.
行为和教育干预是改善健康相关生活质量（HRQOL）的有前景的方法，然而在过敏性肺炎（HP）或其他间质性肺疾病（ILD）中进行此类研究的较少。本研究的目的是收集ILD临床医生关于HP患者HRQOL管理和疾病特异性教育的当前实践与观点、对行为和教育干预的知识与态度，并确定在干预开发过程中临床医生认为可能存在的障碍。
对美国各地的ILD临床医生进行了一项电子调查。使用描述性统计分析调查数据，使用定性内容分析分析开放式问题。
74名临床医生回复了调查，其中93%为医生。所有受访者（100%）表示，为其HP患者提供改善HRQOL的干预措施非常重要或绝对必要。只有5%的临床医生报告目前使用经过验证的评估工具来测量HRQOL。当被问及具体的行为干预技术时，大多数临床医生（92%）报告对同伴辅导干预了解很少或一无所知，对认知行为疗法（CBT）原则了解很少或一无所知（69%）。尽管如此，大多数（68%）临床医生希望能够向患者介绍这些潜在有效的行为干预措施，大多数（67%）临床医生表示希望在干预完成后强化干预原则。将患者转介至虚拟提供的行为干预的感知障碍包括时间限制、所有患者的可及性和获取途径、成本和报销以及技术困难。
本次调查中的临床医生一致认为，HP患者需要改善HRQOL和知识的干预措施。临床医生参与这些干预措施的教育、转介和强化的愿望将需要在开发过程早期对临床医生进行行为策略和实施相关策略的教育。
