CPCI Fact Sheet

The National Institute of Nursing Research in 2005 awarded two grants totaling $2.8 million to UW-Madison School of Nursing to develop customized, information-based strategies for patients. The two grants support the Center for Patient-Centered Interventions (CPCI) and its work in the newly emerging field of patient-centered interventions.

The CPCI focuses on nursing research related to the design and testing of health-promoting, patient-centered interventions. Patient-centered interventions are customized or tailored to an individual's attitudes, beliefs, and values—the characteristics that define an individual's quality of life. Addressing these aspects is key to managing disease, treating illness, or coaching health goals throughout life.

The CPCI provides opportunities for pre- and postdoctoral training as well as for pilot funding of innovative and promising studies in the area of patient-centered interventions. Current studies range from an examination of healthy groups seeking to improve their level of well-being to individuals facing decisions regarding end-of-life care.

Leadership

Sandra Ward, PhD, RN, FAAN, Center Director. Dr. Ward investigates how adults cope with cancer, with a special emphasis on pain and symptom management. She is presently conducting a series of intervention studies testing ways to alter patients' negative ideas about using analgesics, with the ultimate goal of improving pain control for persons with cancer. Professor Ward is a Helen Denne Schulte Professor of Nursing.

Pilot Studies – Year 1

Symptom Management for Older Breast Cancer Survivors Susan Heidrich, PhD, RN

The goal of Dr. Heidrich's pilot study is to determine whether a symptom management educational program for older women can be delivered by telephone rather than in a face-to-face counseling session. Preliminary evidence indicates that the patients view the face-to-face program as helpful and effective. However, it is not always possible to provide one-on-one counseling. If the intervention could be successfully delivered by phone, then health care providers could use this approach to help patients with self-care of symptoms. This solution addresses two problems for elderly women: transportation barriers and the physical burden (most notably, fatigue) of adding more time to a scheduled clinic visit. The pilot study will test the effect of phone intervention on symptom distress and the acceptability of the approach in terms of patient satisfaction and nurse satisfaction.

Predicting Cancer Pain Relief Using Nondrug Strategies Kristine Kwekkeboom, PhD, RN

Cancer pain treatment guidelines recommend combining pain-relieving medications with non-drug interventions to maximize relief. However, current research indicates that there are individual differences in the effectiveness of these non-drug pain treatments. An intervention that is helpful to one patient may be ineffective or even increase pain for another. Individual characteristics may influence the effectiveness of specific nondrug treatments. These characteristics include a) skill or ability to use the treatment, b) outcome expectancy regarding the treatment, c) previous history with the treatment, and d) presence of other symptoms. This pilot project will test the feasibility of studying these individual difference variables as predictors of success with two nondrug interventions (guided imagery and progressive muscle relaxation).

An Individualized Intervention for Prevention Diane Lauver, PhD, APRN, BC, FAAN

Dr. Lauver's work is based on the premise that, if people with sedentary lifestyles and unbalanced diets could improve their preventive behaviors, then they could decrease their risks for developing major chronic diseases and improve their overall health. She is currently testing a patient-centered intervention designed to promote health behaviors and improve health outcomes. The interventions are customized for individuals or groups based on certain characteristics, such as beliefs or behavioral intentions, and are well suited to the promotion of preventive behaviors.

Pilot Studies – Year 2

Implementation of Resident-Centered Caregiving in Long Term Care with an Embedded Mentoring Program Barbara J. Bowers, PhD, RN, FAAN

This pilot/feasibility will compare two methods of collecting data from CNAs about the way they think about and provide care to residents, and the role the nurse plays in the care they deliver. The pilot also compares the attrition rates of nurses in the study using two methods to support/encourage retention and one group with no support. Finally, in addition to the past focus on care quality, this pilot will add an explicit resident-centered dimension to the proposed intervention study planned to follow this pilot study.

Symptom Management and Self-Care Monitoring In Lung Transplant Candidates Dorothy M. Lanuza, PhD, RN, FAAN, FAHA

The primary purpose of this study is to test whether a symptom management intervention can help people who are waiting for a lung transplant to identify and manage symptoms that they feel are most upsetting to them. Secondary purposes are to explore: 1) if the symptom management intervention helps reduce symptoms, 2) the effect that symptoms have on quality of life, 3) whether individuals who are in the symptom management group report greater improvement in quality of life than the routine care group.

Strategic Planning for A Family-Centered Approach for Genetic Counseling Audrey Tluczek, PhD, RN

Dr. Tluczek will collaborate with cystic fibrosis (CF) Center multidisciplinary clinicians to develop a manualized approach that combines patient-centered principles and mental health techniques to address the cognitive and emotional needs of parents whose infants have abnormal DNA analyses from newborn screens (NBS) for cystic fibrosis (CF). This project aims to: 1) develop a manualized family-centered approach to genetic counseling; 2) determine the most appropriate instruments to evaluate this intervention; and 3) establish the validity and reliability of a single-item measure of parental worry.

Pilot Studies – Year 3

Feasibility of Patient Controlled Nondrug Therapy for Pain and Symptom Management in Patients with Cancer Kristine Kwekkeboom, PhD, RN

Dr. Kwekkeboom will assess the feasibility of a patient-controlled nondrug therapy (PCNT) intervention, using an MP3 player to deliver multiple recorded nondrug strategies for cancer-related pain, fatigue, and sleep disturbance during treatment. Specific aims are (1) to assess feasibility of the PCNT intervention in patients receiving treatment for advanced cancer, (2) to evaluate participants' perceptions of the PCNT intervention including changes in symptom intensity, and (3) to determine if patients receiving a particular form of treatment (chemotherapy or radiotherapy) are more amenable to treatment with the PCNT intervention.

Identifying and Addressing the Feeding and Nutrition Issues of Young Children with Special Health Care Needs and Their Families Kristin F. Lutz, PhD, RN

The growing number of preterm infants with increased risk of health problems is a significant public health problem. Overall, there is little known about the family consequences of preterm birth or the interventions most effective for optimizing infant and family outcomes after preterm birth. This study will be an important first step to address the feeding and nutrition problems commonly experienced by preterm infants and collect data on the trajectory of feeding challenges, in order to develop effective interventions.

Smoking Resumption Prevention Intervention for Pregnant Women Pamela Pletsch, PhD, RN

Tobacco-related chronic illnesses are the most preventable health problems in the United States. Effective smoking resumption-prevention interventions for pregnant women who have stopped smoking will move us toward the Healthy People 2010 target of reducing smoking by adults to 12%. The aims of this pilot study are to: a) refine a risk assessment for postpartum smoking resumption that includes bio-behavioral, pregnancy-specific, and co-condition smoking risks, b) assess the feasibility of using telephone counseling to deliver the intervention, c) obtain a preliminary estimate of the magnitude of effect that the intervention has on 3-month postpartum smoking rates.

Pilot Studies - Year 4

What Constitutes an Obesogenic Family Environment?  Susan K Riesch, PhD, RN, FAAN

For the period 1980 to 2004, among children aged 6 to 11 years, the prevalence of childhood oveweight and obesity increased from 6.5% to nearly 19% and among those aged 12 to 19 years, prevalence increased from 5% to 17.4%. The health effects of obesity are staggering and costly. Childhood overweight and obesity is an extremely complex phenomenon.  Though genetic factors are implicated, such dramatic secular increases highlight the importance of environment. An approach that is gaining appeal but that has not been thoroughly studied is the family environment.  Findings from several studies suggest that families in which parents value, set, and achieve a family environment that includes firm and fair limits conveyed in an affectionate manner, is optimal for childhood weight management. Parents whose style is controlling or neglectful may be contributing to overweight and obesity in their child. The purpose of this pilot study is to identify factors contributing to an obesogenic family environment.  We intend to document the indicators of an obesogenic environment through focus group and survey participation by mothers and their 9 to 18 year old children who are seeking care for overweight and obesity at the UW Pediatric Fitness Clinic (n = 60). Survey data will include parent and child perceptions of parenting style using the Parent Acceptance-Rejection Questionnaire/Control, parent modeling behaviors using the Family Activity and Eating Habits Questionnaire, parental perceptions and concerns about the child’s obesity proneness and parent practices using the Revised Child Feeding Practices Questionnaire, child's hesitancy to try new foods using the Food Neophobia Scale for Children, selected mother and child demographics (age, race/ethnicity, income, occupation, education), and child weight status using Body Mass Index (self-report and clinic report) and fat composition using DXA (clinic report). We anticipate that this study will lead to an intervention targeted at modifying parenting skills and processes and lifestyle factors in families that have the indicators of an obesogenic environment.  The public health implication of this study is to examine an important proximal and modifiable factor, family environment, that my contribute to childhood overweight and obesity.

Using maps and graphics to convey geographic and household environmental risk information: Assessing impact on beliefs and behavioral intentions   Dolores J. Severtson, RN, PhD

Visual images can make information easier to comprehend and prompt stronger and more appropriate health beliefs than equivalent text-based information.  Increasingly, maps and graphs of “geographic environmental health risk information” (GEHRI) are used to convey environmental risk information to the public to promote appropriate risk responses that include household screening for the presence of a risk.  Household monitoring information is likely to be interpreted within a context of the GEHRI.  The purpose of this study is to explore how dimensions of GEHRI influence risk beliefs, affect and behavioral intentions to screen for a risk, and then respond to risk screening results.  Specific aims include: 1) exploring private well owners’ qualitative understandings of different versions of GEHRI that vary on 4 dimensions (format, sample-size uncertainty, amount of risk, hazard proximity), 2) developing a survey instrument to measure beliefs, affect, and behavioral intensions to test water and mitigate exposure, and 3) exploring the influence of the 4 GEHRI dimensions on these dependent variables.  Cognitive testing among adult UW students and private well owners will achieve the first two aims.  Two pilot studies, one among 50 private well owners who tested their water through a town-based program and the other among 50 adult UW students, will pre-test the self-administered survey packet and the survey instrument’s ability to measure selected GEHRI influences. A self-administered mailed survey among 1200 adult private well owners will systematically explore the influence of the 4 GEHRI dimensions on dependent variables, including how a water test result is understood within a context of GEHRI.

Feasibility of the Oh Happy Day Depression Intervention (OHDDI)  Earlise Ward, PhD, LP

This P20 proposal addresses the needs of one of the most vulnerable and underserved populations in the United States, older African American women. The primary aims are: 1) test the feasibility and acceptability of the OHDDI intervention, and 2) refine the OHDDI intervention manual. Data from this pilot will support an NIH R34 grant application to test the efficacy of the OHDDI in a larger trial. Older African American women, compared to other women, experience more of the risk factors for depression (e.g., lower incomes, poorer health status) and higher levels of depression symptoms. Yet, older African American women disproportionately receive the least amount of treatment for depression, although antidepressants and psychotherapy in the treatment of major depression in older adults are efficacious. In an effort to improve depression care for older African American women, interventions need to be culturally congruent with the needs, preferences, and cultural learning styles of this largely underserved and underresearched population. The OHDDI was developed to address this deficit. The OHDDI is a 90-minute weekly cognitive behavioral group counseling intervention for 12 weeks. It is community-based in churches and community centers, is delivered jointly by a mental health therapist and a trained paraprofessional community member, and includes psychoeducation with the goal of educating the client about depression and increasing healthy coping behaviors. The proposed research will use a one-group pretest-posttest design. Subjects will be African American women aged 60 and over with depression symptoms. Outcome evaluations will be conducted at baseline, and week 6, 12 and 24 using standardized instruments. Findings from the present study will support evaluation of the OHDDI in a larger randomized control trial (R34).

Contact Information

Center for Patient-Centered Interventions
University of Wisconsin-Madison School of Nursing
K6/397 CSC
600 Highland Avenue
Madison WI 53792-2455

Tel: 608- 263-5277
FAX: 608-263-5296
http://www.son.wisc.edu/cpci/index.htm