Final Research Report
View this project's final research report.
Results of This Project
Related Journal Citations
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
Patient / Caregiver Partners
- COPD Patient Co-investigator
- COPD Family Caregiver Co-investigator
Other Stakeholder Partners
- Carol Sylvester, Stakeholder Co-investigator
- Has Results