Results Summary

What was the research about?

Chronic obstructive pulmonary disease, or COPD, is a lung disease that makes it hard to breathe. Managing symptoms of COPD may improve patients’ quality of life and reduce the need for urgent healthcare visits.

In this study, the research team wanted to learn if including peer support in a COPD self-management support program improved quality of life and reduced use of urgent health care. Peer support included outreach from a peer supporter and group meetings with other patients and family caregivers. Peer supporters had well-managed COPD and had received training to provide support. The team compared patients receiving self-management support with and without peer support.

What were the results?

After six months, patients with and without peer support didn’t differ in quality of life.

During the program, patients with peer support had fewer COPD-related hospital and emergency room, or ER, visits than patients without peer support. This difference wasn’t present at nine months—three months after peer support ended.

At nine months, patients with and without peer support didn’t differ in the overall number of hospital and ER visits for any cause or rate of deaths.

Who was in the study?

The study included 292 patients with COPD and 50 family caregivers. Patients received care at clinics within a health system in Maryland. Of these patients, 71 percent were White, 26 percent were African American, and 3 percent were another race. The average age was 67, and 61 percent were women.

What did the research team do?

The research team assigned patients by chance to the self-management support program with or without peer support. In the program, a respiratory therapist met with patients and their family caregivers for one hour. The therapist described how to use medicines, inhalers, and oxygen and provided a written guide and contact information for follow-up questions.

In the peer support group, patients and caregivers received the same program. The research team also matched each patient with a peer supporter for one-on-one support. In addition, patients could attend up to eight group meetings over six months. At these meetings, patients talked about living with and managing COPD.

The research team interviewed patients in person at the start of the study and again by phone three, six and nine months later. The team collected data about hospital and ER visits from the state of Maryland.

Patients with COPD and their caregivers, healthcare providers, and patient advocates gave input throughout the study.

What were the limits of the study?

This study took place in one health system in one state. Results may differ in other states or health systems. Many patients didn’t take part in the peer support activities, which may have affected study results.

Future research could look at ways to encourage more patients to take part in peer support activities.

How can people use the results?

Health systems can use these results when considering how to support patients with COPD.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers asked whether the definition of adherence to the intervention developed before or after the researchers saw the attendance results. The researchers confirmed that they established the adherence definition as part of the statistical analysis plan and before the study interventions and data collection were completed. The researchers based their definition of adherence, defined as attending half of planned peer encounters, on earlier studies of group interventions and on early stages of the trial.
  • The reviewers noted that a major problem with the study was that the low levels of participation in peer support meetings and calls hampered the ability to assess the efficacy of peer support. The reviewers asked about possible barriers to participation. The researchers responded that peer support participation was low mainly for reasons that did not relate to the content or organization of the peer support sessions, such as being too sick, having transportation issues, and having other medical problems that were more important at the time. Many study participants were recruited when they were hospitalized, and not necessarily for respiratory conditions, and some were sent to rehabilitation facilities or were rehospitalized, which interfered with their ability to participate in peer support activities. Participation was higher among patients recruited from an outpatient setting.
  • The reviewers commented that the participation rates seemed low especially in contrast to the enthusiasm participants expressed about keeping the peer support program running longer. The researchers said that the most frequently requested improvement to the program was to continue the peer support intervention. The researchers noted that participants often have times when they are too ill or have too many other commitments to participate in the peer intervention but would like to have the continued opportunity to participate when they are able to do so.
  • Reviewers questioned the researchers’ conclusions that living alone was an important contributor to poor treatment adherence, stating that the presented data pointed more to socioeconomic barriers as contributing to poor adherence.  The researchers agreed that the results appear to indicate that differences in socioeconomic factors like education and income contributed to adherence differences among participants but went on to say that it was difficult to tease out whether poor adherence was actually driven by higher disease burden among participants with low socioeconomic status. The researchers also conducted more detailed analyses looking at variables that might have affected intervention adherence. They found that lower education level and lower self-reported emotional health significantly related to lower adherence.
  • Reviewers asked the researchers to speculate on why in the program incorporating peer support, caregivers showed increases in emotional support while patients in the same program showed increases in informational and instrumental support. The researchers posited that because caring for a loved one with chronic obstructive pulmonary disease can be very stressful, caregivers needing more emotional support may have been more interested in and driven to participating in the intervention and therefore were more likely to benefit. The researchers went on to say that while patients may receive emotional support from their family members and healthcare professionals, caregivers may not want to increase the burden on family and friends by sharing their own concerns.

Conflict of Interest Disclosures

Project Information

Hanan J. Aboumatar, MD, MPH
Johns Hopkins University
Comparing Effectiveness of Self-management and Peer Support Communication Programs amongst Chronic Obstructive Pulmonary Disease Patients and their Family Caregivers

Key Dates

April 2016
March 2021

Study Registration Information


Has Results
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Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
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Last updated: November 30, 2022