When Professor Paula Meek, PhD, RN, FAAN, started her career as a nurse in a cardiac step-down unit about 25 years ago, she was stricken by the different levels of care provided to cardiac patients compared to pulmonary patients. She observed pulmonary patients sitting in their rooms struggling to breathe for days while they waited for their medication to help, and they received very little attention and education about their chronic illness.
“It became blatantly obvious to me that we were pouring resources into one area and not doing much for the other,” Dr. Meek says. “I got into pulmonary care [and symptom management] right away. I wanted to find something that would facilitate or help people with chronic diseases like COPD through that acute period of chronic illness.”
“I decided I needed to do pulmonary symptom research because everybody was looking at drugs. Nobody was looking at cognitive function and how that could impact that symptom.” Breathlessness, she says, has a huge number of sensory mechanisms, and dyspnea can be triggered if they’re even slightly off. The complexity of determining the causes and improving treatment intrigued her.
Meek was also interested in how cognitive function and attitude affected chronic pulmonary disease. Once, Meek says, she had two patients present with the same pulmonary function and medication regime. They looked similar on paper but one was in a wheelchair and struggling significantly; the other was eager to get out of the clinic to go shopping. The relatively healthier patient told Meek she’d made a choice to remain active and commit to staying positive. “That just made me want to learn from the patients who had adjusted to their chronic illness and figure out how to get others to that point.”
In 2012, Meek and her nursing colleagues applied for a NIH Center Grant to start a center to research symptom management and fatigue symptoms in a way that marries markers and behavioral influences on fatigue. There are pilot projects for each of three populations: those with a chronic disease (COPD or congestive heart failure), healthy caregivers, and individuals who have sleep disturbance from previous cancer treatment. She hopes the study will find any common fatigue-related symptoms in all populations in order to determine uniform, effective interventions.
Dr. Meek is also working on several projects with CU School of Medicine colleagues: a treatment grant with Associate Professor David Bekelman, MD, and an R01 grant with Professor Barry Make, MD. Her work with Dr. Bekelman is a randomized controlled study that addresses depression, pain, fatigue and breathlessness. “It is a really intense medical intervention to try to help with these chronic medical symptoms that don’t go away. We’re trying to reduce the impact of them.”
The R01 grant with Dr. Make will use NIH’s Patient-Reported Outcomes Measurement Information Systems (PROMIS) to facilitate comprehensive testing of symptoms like fatigue.
Where in the past, you could create a research niche for yourself, she says, now you need to back up innovative idea with a team of experts across disciplines in order to compete for funding.
“We really work with each other at a more basic level all the time,” she says, “and I believe we’re on the forefront of coming developments in research.”