contemplation objectives: To test the efficacy of a tailored telephone-based intervention consisting of supportive counseling and cognitive behavioral techniques for individuals awaiting lung transplantation onward measures of quality of life and general well-being.

Method: Patients were randomly assigned to either a telephone-based special intervention (SI; n = 36) for 8 weeks (average session detail 16.3 min) or a usual care (UC) direct condition (n = 35) in which controls received usual medical care further no special treatment or phone calls. At baseline, and immediately following the 8-week intervention, patients complet a psychometric standard battery. Setting: Duke University Medical Center Pulmonary Transplantation Program.

Patients: Seventy-one patients with end-stage pulmonary disease listed for lung transplantation. Primary issue measures: Measures of health-related quality of life (both general and disease-specific), general psychological well-being, and social support.

Results: Multivariate analysis of covarianee, adjusting for pretreatment baseline scores, age, sex and time wailing on the transplant list, revealed that patients in the SI condition compared to the UC reported greater general well-being (p < 005) better general quality of life (p < 001) better disease-specific quality of life (p < 005) and higher evens of social support (p < 00001)

Conclusion: A brief, relatively inexpensive, telephone-based psychosocial intervention is an effective rule for reducing distress and increasing health-related quality of life in patients awaiting lung transplantation.

first note of the scale words: counseling; lung transplantation; quality of life; stress

Abbreviations: ANCOVA = analysis of covariance; GHQ = general health questionnaire; MANCOVA = multivariate analysis of covariance; PQL = pulmonary-specific quality-of-life scale; SF-36 = short form-36; SI = special intervention; UC = usual care

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Lung transplantation now shows a viable therapeutic option for many patients with advanced pulmonary parenchymal or pulmonary vascular diseases. Despite the relatively modern introduction of this procedure, happy shortterm outcomes are reported at principally centers, (1) with 1-year survival rates approaching 80% Long-term issues remain disappointing, however, with 5-year survival rates of sole approximately 50%. (1-6) Because of the limited long-term posttransplant survival rate, solely patients with severe end-stage lung disease and a remarkably limited life expectancy are considered for the operation. However, owing to the severity of the disease, the defered waiting times until transplantation, and the high likelihood of death prior to receiving a transplant (eg from July 1 1999 to June 30 2000 883 patients underwent lung transplantation, while 553 patients died while waiting for a transplant), (1) lung transplant candidates frequently experience high levels of psychological distress.

Preliminary studies confirm high rates of anxiety and depression among

patients with end-stage lung diseases like as COPD. (7-9) Furthermore, psychological dysfunction and distress appear to be especially prevalent in those patients awaiting lung transplantation. (10) Prior studies have reported that pretransplant psychosocial factors, as it was as quality of life, depression, coping, and perceived social support, can adversely affect medical issues in a variety of chronic diseases, (11-15) including lung disease. (1617) Little is known, however, regarding the impact of these factors upon preoperative or postoperative lung transplantation issues Moreover, there is little empirical research forward the effects of modifying these psychosocial variables, particularly during the proces of waiting for an organ.

It has been demonstrated that psychosocial interventions can enhance coping skills and improve quality of life and well-being in patients with chronic medical conditions as it is as HIV/AIDS, (18,19) cancer, (20) and heart disease. (2122) The use of telephone-based interventions has gained increased attention as a viable alternative to conventional counseling. (23-25) Because patients awaiting lung transplantation at short intervals live far from major medical center and frequently do not have access to mental health services that are familiar with the unique issues facing transplant recipients, a telephone intervention provided by dint of trained clinicians represents a practical and novel approach to improve well-being among patients listed for lung transplantation. The intention of the present study, therefore, was to examine the efficacy of a telephone-based psychosocial intervention in reducing distress and improving health-related quality of life in patients awaiting lung transplantation.

MATERIALS AND METHODS

Patient Population

Ninety-one lung transplant candidates who were listed for lung transplantation at Duke University Medical Center between October 1997 and April 1998 were initially contacted to be part of this research Every patient who was listed for a transplant during that time period was approached to participate in the inquiry Of the 91 patients who were contacted, 81 (89%) initially agreed to be part of the close attention and provided written informed harmony approved by the institutional review board at Duke University Medical Center There were no differences with reverence to age, gender, transplant status, time wearied waiting on the transplant list, functional capacity, or disease severity between those who declined to participate and those who agreed. Of the 81 enthralls initially recruited for the inquiry 2 subsequently were taken against the transplant list, 1 underwent transplantation prior to completing the baseline evaluation, 6 withdrew their co-operation and 1 died, leaving a final sample of 71 participants. The mostly common diagnoses were COPD, primary pulmonary hypertension, and cystic fibrosis. Other medical diagnoses included [[alpha].sub.1]-antitrypsin deficiency, pulmonary fibrosis, lymphangioleiomyomatosis, bronchiectasis, sarcoidosis, and Eisenmenger syndrome

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