Table 1.

Personalized Intervention for Depression and COPD (PID-C)^*

Session 1 (Rehabilitation Hospital)

Introduction of the Role of Care Manager

Describe the adherence enhancement intervention and explain how it might help

Assessment of Causes of Non-Adherence

Use this guide to identify causes of non-adherence in each individual patient

Misconceptions about COPD and depression

Misunderstanding about treatment and about the actual regimen

Misattribution of depressive symptoms

Hopelessness

Overestimation of the energy needed to perform daily exercises

Dissatisfaction with prior treatment or after-care arrangements

Practical barriers to treatment, e.g. scheduling visits and access to care, transportation, finances.

Education

Brief discussion of facts about depression and its impact on the care of COPD

Sessions 2–9 (At Home)

Ongoing Assessment

Depressive symptoms, dyspnea-related disability

Treatment recommendations (rehabilitative, medical, psychiatric) and barriers to adherence

Address Barriers to Adherence

Focus on causes of non-adherence pertinent to the individual patient

Misconceptions about COPD and depression: Address incorrect facts about COPD and depression, recognize and address stigma

Misunderstanding about the actual regimen: Discuss the role of prescribed treatment and exercise in reducing dyspnea and disability and in preventing exacerbations

Misattribution of depressive symptoms: Identify likely contributors to symptoms and clarify the role of prescribed antidepressant treatment in reducing them

Hopelessness: Identify hopelessness as a symptom of depression that fuels poor expectations about treatment.

Discuss the role of antidepressant treatment and exercise in improving function and in conferring a feeling of empowerment. Offer support.

Overestimation of the energy needed to perform daily exercises: Describe in realistic terms what needs to be done, when, and how.

Dissatisfaction with after-care: Help patient develop a plan to address concerns (e.g., coach patient to express their concerns and ask question of health professionals)

Practical barriers: Help patients develop concrete strategies to address practical issues (e.g., identify ways to attend appointments; devise reminders for taking medications and conducting exercises; enlist help of family members and social services).

Collaboration with Physicians

Inform the physicians about any significant changes in the patients’ status as well as any problems with adherence, and engage them in addressing them. Discuss depression treatment guidelines.

^*The Manual is available on request (gsalexop@med.cornell.edu)