Psychoeducational Intervention for ICD Patients (PEACE)

NCT ID: NCT00146679

Last Updated: 2013-09-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

246 participants

Study Classification

INTERVENTIONAL

Study Start Date

2001-03-31

Study Completion Date

2006-02-28

Brief Summary

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The overall purpose of this study is to test the effects of a nurse managed psychoeducational intervention, consisting of symptom management training (SMT) and cognitive-behavioral intervention (CBI), during the first year after ICD implantation using a 3 group randomized clinical trial.

Detailed Description

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Symptom distress and persistent physical and psychological changes characterize early and ongoing recovery from ventricular dysrhythmia and treatment with an implantable cardiac defibrillator (ICD). This study will test the effect of a psycho educational intervention on psychological and physical outcomes in the first 12 months after ICD implantation. Primary outcome measures are anxiety, depression, and functional status. The effect of the intervention on variables that mediate adaptation and outcomes (symptoms, illness appraisal, and coping behaviors) will also be examined. Secondary aims will examine subsequent arrhythmia events (ICD delivered therapy) and health resource utilization in relation to the main outcomes. The intervention and study variables are based on stress and coping theory and previous research with ICD patients, which documented negative outcomes of ineffective coping and compelling relationships between increased emotional distress and subsequent arrhythmia events.

A three-group, randomized, clinical trial with a repeated-measures design will be used. ICD patients (n=240) will be randomized to receive either the usual standard of care, symptom management training plus cognitive behavioral intervention delivered in a group format, or symptom management training plus cognitive behavioral intervention delivered by nurse provided telephone counseling. The symptom management-training component will be provided in the acute care setting and will focus on symptoms of pain, sleep disturbances and ICD shocks. The four cognitive behavioral sessions by group or telephone format will begin 6-8 weeks after hospitalization and will focus on illness reappraisal and coping skill training. Thus the intervention is designed to bridge the acute and outpatient continuum of care. A booster intervention will be provided at 4 months after implantation. Timeframes for evaluations are baseline, 1, 3, 6, and 12 months after implantation. This study will test whether a cost-effective, accessible, theoretically based, nurse-managed, psycho educational intervention provides an incremental effect over usual care in improving psychological and physical outcomes in ICD patients. This study will provide data upon which future clinical practice guidelines can be based and will establish priorities for patient care according to which interventions are linked to improved adaptive processes and patient outcomes. Greater understanding of the relationships among psychological and physical outcomes, arrhythmia events, and health resource utilization are important for future studies and evaluation of clinical practice with ICD patients.

Conditions

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Heart Failure Ventricular Arrhythmias

Keywords

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Heart failure Ventricular arrhythmias ICD Psychoeducational intervention

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Usual Care (UC)

Usual Care provided by providers

Group Type PLACEBO_COMPARATOR

Usual Care

Intervention Type BEHAVIORAL

Usual Care provided by providers

Psychoeducational Telephone CounselingTC

Education and Counseling for ICD patients provided through Telephone Contact

Group Type ACTIVE_COMPARATOR

Psychoeducational Telephone counseling (TC)

Intervention Type BEHAVIORAL

Educational and Counseling, symptom management training and cognitive behavioral intervention to teach coping skills provided through telephone sessions

Psychoeducation through Groups (SG)

Education and Counseling for ICD patients provided in a group setting with other ICD Patients

Group Type ACTIVE_COMPARATOR

Psychoeducational Intervention by Group (SG)

Intervention Type BEHAVIORAL

Educational and Counseling, symptom management training and cognitive behavioral intervention to teach coping skills provided in 4 group sessions

Interventions

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Psychoeducational Telephone counseling (TC)

Educational and Counseling, symptom management training and cognitive behavioral intervention to teach coping skills provided through telephone sessions

Intervention Type BEHAVIORAL

Psychoeducational Intervention by Group (SG)

Educational and Counseling, symptom management training and cognitive behavioral intervention to teach coping skills provided in 4 group sessions

Intervention Type BEHAVIORAL

Usual Care

Usual Care provided by providers

Intervention Type BEHAVIORAL

Other Intervention Names

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TC SG UC

Eligibility Criteria

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Inclusion Criteria

* All subjects must have a nonthoracotomy insertion
* Have a primary cardiac etiology of their ventricular arrhythmia (coronary artery disease, cardiomyopathy, valve dysfunction, or combination)
* Be fluent in English
* Live within a 75 mile radius of the coordinating center
* Be accessible by telephone
* Only those receiving their first ICD, not replacement generators, will be entered.

Exclusion Criteria

* Being evaluated or on a waiting list for heart transplantation
* Congenital disease or long QT syndrome
* Disorientation documented in the pre-implantation hospitalization period
* History of psychiatric disorder or progressively debilitating comorbidity that would confound outcome measures
Minimum Eligible Age

21 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institutes of Health (NIH)

NIH

Sponsor Role collaborator

Emory University

OTHER

Sponsor Role lead

Responsible Party

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Sandra B. Dunbar, RN

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Sandra B. Dunbar, RN, DSN

Role: PRINCIPAL_INVESTIGATOR

Emory University School of Nursing

Locations

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Crawford Long Hospital

Atlanta, Georgia, United States

Site Status

Piedmont Hospital

Atlanta, Georgia, United States

Site Status

Emory University Hospital

Atlanta, Georgia, United States

Site Status

St. Joseph's Hospital

Atlanta, Georgia, United States

Site Status

Atlanta VA Medical Center

Decatur, Georgia, United States

Site Status

Countries

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United States

References

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Dunbar SB. Psychosocial issues of patients with implantable cardioverter defibrillators. Am J Crit Care. 2005 Jul;14(4):294-303.

Reference Type BACKGROUND
PMID: 15980420 (View on PubMed)

O'Brien MC, Langberg J, Valderrama AL, Kirkendoll K, Romeiko N, Dunbar SB. Implantable cardioverter defibrillator storm: nursing care issues for patients and families. Crit Care Nurs Clin North Am. 2005 Mar;17(1):9-16, ix. doi: 10.1016/j.ccell.2004.09.002.

Reference Type BACKGROUND
PMID: 15749396 (View on PubMed)

Dunbar SB, Funk M, Wood K, Valderrama AL. Ventricular dysrhythmias: nursing approaches to health outcomes. J Cardiovasc Nurs. 2004 Sep-Oct;19(5):316-28. doi: 10.1097/00005082-200409000-00007.

Reference Type BACKGROUND
PMID: 15495892 (View on PubMed)

Berg SK, Higgins M, Reilly CM, Langberg JJ, Dunbar SB. Sleep quality and sleepiness in persons with implantable cardioverter defibrillators: outcome from a clinical randomized longitudinal trial. Pacing Clin Electrophysiol. 2012 Apr;35(4):431-43. doi: 10.1111/j.1540-8159.2011.03328.x. Epub 2012 Feb 3.

Reference Type RESULT
PMID: 22303998 (View on PubMed)

Dunbar SB, Langberg JJ, Reilly CM, Viswanathan B, McCarty F, Culler SD, O'Brien MC, Weintraub WS. Effect of a psychoeducational intervention on depression, anxiety, and health resource use in implantable cardioverter defibrillator patients. Pacing Clin Electrophysiol. 2009 Oct;32(10):1259-71. doi: 10.1111/j.1540-8159.2009.02495.x.

Reference Type RESULT
PMID: 19796343 (View on PubMed)

Smith G, Dunbar SB, Valderrama AL, Viswanathan B. Gender differences in implantable cardioverter-defibrillator patients at the time of insertion. Prog Cardiovasc Nurs. 2006 Spring;21(2):76-82. doi: 10.1111/j.0889-7204.2006.04843.x.

Reference Type RESULT
PMID: 16760689 (View on PubMed)

Related Links

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http://www.ncbi.nlm.nih.gov/pubmed/22303998

LInk to PubMed reference site for Berg, SK et al 2012

http://www.ncbi.nlm.nih.gov/pubmed/19796343

link to PubMed reference for study results by Dunbar, SB et al 2009

Other Identifiers

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SR01 NR 5187-03

Identifier Type: -

Identifier Source: secondary_id

0430-1999

Identifier Type: -

Identifier Source: org_study_id