Data Collection
Measurement was performed at baseline (T1) within 72 hours after enrolling in the study and at 10-month follow-up (T2). Intervention nurses who were blinded to the group assignment, collected data at patients’ homes. A 10-month study duration was presumed to be sufficient to expose patients to randomly occurring triggers of uncertainty about possible COPD exacerbations. Patients in the intervention group were called monthly for 10 months by intervention nurses following a standard protocol. During the phone call, the patients were asked about triggers experienced in the past month, whether strategies on the audio CD were used to manage the triggers, which strategies were used, and helpfulness of the strategies. These questions were used to inquire about symptoms and use of the manual.
Intervention
The uncertainty management intervention included: (a) cognitive strategies taught in an audio CD to teach coping responses when experiencing triggers of uncertainty about exacerbation; (b) behavioral strategies described in a 90-page self-help manual, including management skills, information, and COPD resources (Table 1); (c) four telephone contacts during the first 4 weeks to guide the patients in use of the cognitive and behavioral strategies covered in the audio CD and the manual. The audio CD, the self-help manual, an instruction booklet, and tools to prompt use of certain skills (e.g., laminated cards describing the steps to relax and use calming self-talk) were given to the patients in a binder. The four telephone contacts were delivered by intervention nurses following a standardized protocol (one telephone contact each week for 4 weeks, approximately 35 minutes each call). The patients practiced one cognitive coping skill during each call: distraction, calming self-talk, relaxation, and pleasant imagery. The intervention nurses instructed the patients to use the skills whenever facing or anticipating a trigger of fear of exacerbation. In the third and fourth telephone calls, the nurses instructed the patients on how to use the self-help manual. The nurses also explained to the patients that the manual would not replace standard medical care, that it could only help reduce but not eliminate uncertainty, and that research had indicated that such information could help people better cope with their health problems. During each of the four telephone sessions, nurses encouraged the patients to listen to the audio CD and use the manual in the following week. In he control group, the patients’ exposure to contexts where they might learn similar skills, such as media coverage of COPD issues and public health programs, was not limited.