Rationale: Many survivors of critical illness and their family members experience significant psychological distress after discharge. Objectives: To compare effects of a coping skills training (CST) program with an education program on patient and family psychological distress. Methods: In this 5-center clinical trial, adult patients who received mechanical ventilation >48 hours and one family member of each patient were randomized to six weekly CST telephone sessions plus access to a study website or a critical illness education program. Measurements and Main Results: The primary outcome was the patient Hospital Anxiety and Depression Scale (HADS) at 3 months. Secondary outcomes included 3- and 6-month HADS subscales and the Impact of Events Scale-Revised. Among the 175 patients randomized to CST (n=86) or education (n=89), there was no significant difference between CST and education in either 3-month HADS scores (difference 1.3 [95% CI: -0.9, 3.4], p=0.24) or secondary patient and family outcomes. In pre-specified analyses, among patients with high baseline distress (n=60), CST recipients had greater improvement in 6-month HADS score (difference -4.6, [95% CI: -8.6, -0.6], p=0.02) than education. Among patients ventilated >7 days (n=47), education recipients had greater improvement in 3-month HADS score (difference -4.0 [95% CI: -8.1,-0.05] p=0.047) than CST. Conclusions: CST did not improve psychological distress symptoms compared to an education program. However, CST improved symptoms of distress at 6 months among patients with high baseline distress while the education program improved distress at 3 months among those ventilated for >7 days. Future efforts to address psychological distress among critical illness survivors should target high-risk populations. Clinical trial registration available at www.clinicaltrials.gov, ID NCT0198325

中文翻译：

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与针对严重疾病幸存者及其家人的教育计划相比，基于电话和网络的应对技能训练计划的效果：一项随机临床试验

理由：许多重病幸存者及其家人在出院后会遭受严重的心理困扰。目的：比较应对技巧培训（CST）计划和教育计划对患者和家庭心理困扰的效果。方法：在这个5中心的临床试验中，接受机械通气> 48小时的成年患者和每位患者的一名家庭成员被随机分配到每周六次的CST电话会议以及访问研究网站或危重病教育计划的机会。测量和主要结果：主要结果是患者在3个月时的医院焦虑和抑郁量表（HADS）。次要结果包括3个月和6个月的HADS子量表以及修订后的事件影响量表。在175例接受CST（n = 86）或受教育程度（n = 89）的患者中，在3个月的HADS评分（差异1.3 [95％CI：-0.9，3.4]，p = 0.24）或继发患者和家庭结局方面，CST和教育水平之间无显着差异。在预先指定的分析中，基线窘迫程度高（n = 60）的患者中，CST接受者的6个月HADS评分改善更大（差异-4.6，[95％CI：-8.6，-0.6]，p = 0.02）比教育。在通气时间大于7天的患者中（n = 47），受教育者的3个月HADS评分比CST有更大的改善（差异-4.0 [95％CI：-8.1，-0.05] p = 0.047）。结论：与教育计划相比，CST并未改善心理困扰症状。然而，CST改善了基线高危患者在6个月时的困扰症状，而教育计划改善了通气时间> 7天的患者在3个月时的困扰。应对重大疾病幸存者心理困扰的未来工作应针对高风险人群。可在www.clinicaltrials.gov上获得临床试验注册，ID NCT0198325