Dyspnea Self-Management: Internet or Face-to-Face

University Of California, San Francisco, San Francisco CA

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Abstract

Dyspnea or shortness of breath is the most common disabling symptom in patients with chronic obstructive pulmonary disease (COPD). The increased availability and growing acceptance of emerging technologies as a channel for health communication has opened up opportunities to provide convenient and seamless support for self-management of dyspnea and related symptoms to greater numbers of individuals. The overall goal of this proposal is to compare the impact of a new Internet dyspnea self-management program (i-DSMP) with a face-to-face program (f-DSMP) that has been shown to be effective in patients with COPD. It is hypothesized that there will be no significant differences between the i-DSMP and the f-DSMP in the primary outcomes of dyspnea with ADL, pulmonary exacerbations, exercise performance and adherence secondary outcomes of perception of social support, self-efficacy for managing dyspnea exercise, health resource utilization, and satisfaction with program at 3,6, and 12 months. Secondary aims are to relate subject usage patterns and satisfaction to changes in outcomes and to describe changes in symptom clusters and exercise patterns before, during and after acute exacerbations. Subjects with COPD who are currently using the Internet (N= 200) will be randomized to i-DSMP, f-DSMP, or Attention Control. Guided by physiological concepts, Social Cognitive Theory, and the Transtheoretical Model, the programs include: 1) initial face-to-face dyspnea interview and exercise consultation, 2) dyspnea education, 3) individualized exercise program, 4) self monitoring of exercise and symptoms, and 5) reminders and reinforcement of exercise. The i-DSMP will use online interactive learning modules, text chats, and bulletin board for communication and education and a wireless device (PDA) for monitoring symptoms, exercise, and to receive reinforcement for exercise. The f-DSMP will meet face-to-face, use written logs, and receive telephone reinforcement. If this i-DSMP is as effective as the f-DSMP, it will represent a first step in establishing an evidence-base for widespread implementation of self-management programs for people with symptoms of chronic illness using the Internet and mobile environments.