Living with chronic obstructive pulmonary disease: developing conscious body management in a shrinking life-world

Evaluation of a multi-modal grounded theory approach to explore patients’ daily coping with breathlessness due to chronic obstructive pulmonary disease

Conventional methods have not yet succeeded in capturing the complexity of how people with chronic obstructive pulmonary disease (COPD) cope with breathlessness during daily living. We used a multi-modal grounded theory (GT) approach to investigate coping. In this paper, we describe and evaluate the multi-modal GT approach, which encompasses videos of daily life activity, interviews, medical history, demographics, self-rated sensation of breathlessness, and physiological measurements. A formative evaluation was conducted according to the criteria that the data collection should strengthen the participants’ ability to remember and narrate how they cope with breathlessness; capture the multidimensional aspects involved in coping with breathlessness; encompass tools for collecting both qualitative and quantitative data, providing the opportunity to generate, synchronize, and combine data; and be ethically justifiable. The approach should also be consistent with the GT methodology of generating a theory. Striving to develop and perfect the multi-modal GT approach was time-consuming. Apart from this practical challenge, the multimodal GT approach met all evaluation criteria. This approach has the potential to generate new knowledge and may become an important methodological contribution towards understanding the multidimensionality of coping with breathlessness.

The impact of caring for those with chronic obstructive pulmonary disease (COPD) on carers' psychological well-being: a narrative review

OBJECTIVE

To identify and summarise studies of the psychological well-being of informal carers of people with chronic obstructive pulmonary disease.

DESIGN

The review included studies if they reported the carers perspective of caregiving - studies that focused mostly on the person with chronic obstructive pulmonary disease were included only if the carers perspective of the caregiver role could be extracted.

DATA SOURCES

Electronic searches of MEDLINE, CINAHL, PsychInfo, Sociological Abstracts and The Cochrane Library were carried out between December 2008 and February 2009, with update searches undertaken in June 2011.

REVIEW METHODS

A narrative approach was adopted to evaluate studies according to their contribution and drew together evidence from a range of methodologies, including qualitative and quantitative studies.

RESULTS

Twenty studies were included in this review. Twelve studies focuses only on the caregiver (quantitative studies=7 and qualitative studies=5) and eight included caregivers and the person with chronic obstructive pulmonary disease (quantitative=6 and qualitative=2). Common methodological limitations of studies included in this review were a lack of non-caregiver age-matched comparison groups, focus on the experience of female carers, small sample sizes, and failure to follow-up caregivers longitudinally. Seven studies provided estimates of the prevalence of psychological distress among caregivers but no conclusions could be drawn from the current evidence base. The totality of the current evidence-base suggests that many factors are related to caregiver psychological distress, but it is not possible to gauge the prevalence of this at present.

CONCLUSION

Further studies are needed to clarify the prevalence of chronic obstructive pulmonary disease caregivers' psychological comorbidity and disease specific factors that predict poorer carer health outcomes. That work will enable appropriate interventions to be developed and evaluated.

Factors influencing self-management in chronic obstructive pulmonary disease: an integrative review

BACKGROUND

Chronic obstructive pulmonary disease is a common, chronic and burdensome condition requiring the individual to engage in a range of self-management strategies. The capacity to engage in self-management is dependent on a range of internal (e.g., personal) and external (e.g., health service) factors.

OBJECTIVES

This paper seeks to define self-management, identify the determinants which influence the individual's ability to cope and adjust to living with chronic obstructive pulmonary disease in the community, and identify implications for clinical practice and research.

DESIGN

Integrative review.

DATA SOURCES

Medline, Embase, PubMed, CINAHL, Google Scholar.

REVIEW METHODS

Integrative review using prospective research questions. Papers were included in the review if they were published in peer reviewed journals and written in English between 2000 and 2010. Articles were accepted for inclusion if they discussed the determinants that influenced self-management of chronic obstructive pulmonary disease in the community. Confirmation of results and discussion themes was validated by specialists in chronic obstructive pulmonary disease and complex care.

FINDINGS

Self-management is less well characterised in chronic obstructive pulmonary disease compared with other chronic conditions. Functional limitation and the need to balance disease management with everyday life are the two key elements that patients face in managing their condition. Provider characteristics, socioeconomic status and health literacy are sparsely discussed yet are known to influence chronic obstructive pulmonary disease self-management.

CONCLUSIONS

Chronic obstructive pulmonary disease self-management must be a key focus internationally as the disease incidence increases. Collaborative care is required between patients and health providers in order facilitate patients in confident management of their condition.

Patients' experiences of health transitions in pulmonary rehabilitation

People who live with chronic obstructive pulmonary disease (COPD) experience major changes in health. Coping with the illness and caring for themselves places extensive demands on them. Thus, pulmonary rehabilitation (PR) is recommended as a means to facilitate healthy transitions in everyday life with COPD. This study explores the experience of patients with COPD in terms of their transitions in health during and after PR. The research was inspired by interpretive phenomenology. Thirty-three individual qualitative interviews were conducted with eighteen patients recruited from Norwegian PR units. A thematic analysis of the interviews was performed. The interviewees described participation in PR as a time of increasing awareness of opportunities for health and well-being with strengthened hope. The year following PR was dominated by their ongoing challenge to acknowledge limitations and explore opportunities in everyday life. Continuation of healthy transitions was facilitated by peer and professional support. The study highlights the personal resources that patients with COPD have access to in order to promote their own health. The study also highlights their vulnerability during illness and rehabilitation. The findings critique time-limited PR and support the current trends towards patient-centred rehabilitation efforts that incorporate user involvement and self-management education.

Struggling to retain living space: patients' stories about living with advanced chronic obstructive pulmonary disease

AIM

This paper is a report of a study of the experience of living with advanced chronic obstructive pulmonary disease and long-term oxygen therapy when living alone.

BACKGROUND

Chronic obstructive pulmonary disease affects an increasing number of people. Breathlessness, fatigue and dejection are common symptoms during the last years of life.

METHOD

Repeated qualitative interviews with four participants were conducted over an 8-month period in 2008. The data comprised 17 interviews, 15 telephone conversations and various field notes. A phenomenological hermeneutical method was used to interpret the text.

FINDINGS

The analysis resulted in two main themes and five sub-themes. The first main theme, Being subordinated to the sick body, implies that the body, assistive devices and entrusting oneself to the hands of others can both extend and restrict the living space. The second main theme, Protecting significant values of identity, encompasses both the struggle to maintain self-image and the awareness of one's own death.

CONCLUSION

Living alone with advanced chronic obstructive pulmonary disease is a challenging and complex phenomenon. The everyday life was characterized by a struggle to keep autonomy during a time of increasing dependency and need for help. A person-centred nursing care, built upon peoples' own experiences, may be one way to promote identity and dignity in patients even when they are close to death.

'Belonging'. 'Patients' experiences of social relationships during pulmonary rehabilitation

AIM

To unpack and interpret descriptions of experiences of social relationships during pulmonary rehabilitation (PR) for people living with chronic obstructive pulmonary disease (COPD).

METHOD

Inspired by interpretive phenomenology, individual qualitative interviews were conducted twice with 18 persons from COPD rehabilitation units in two general hospitals. Qualitative content analysis was performed.

RESULTS

Analysis of the interviews revealed the overarching theme of belonging. The participants emphasised social integration in rehabilitation groups as well as support from peers and health-care personnel as important dimensions of social relationships with regard to PR. Active participation in and engagement with the groups provided opportunities for patients to share their knowledge, encouraged mutual trust, and support and increased self-confidence, and motivation for self-care and further social participation. Integration in the groups and perceived support during PR made coping and adaptation easier and had a positive effect on quality of life.

CONCLUSIONS

Patients' perspectives on PR were strongly influenced by certain facets of social relationships, such as social integration and social support. Patients', peers' and health-care professionals' strategies to promote social support and social integration should be further explored in the future, both in different contexts and for longer periods of time.

Taking a chance: the experience of lung volume reduction procedures for chronic obstructive pulmonary disease

OBJECTIVES

Lung Volume Reduction Surgery and Endo-Bronchial Valve(TM) insertion have expanded the therapeutic choices for chronic obstructive pulmonary disease (COPD). Controversy over efficacy, costs and risks limits access to these therapies. There are no published findings to guide our understanding of the patient's experience of surgery. The aim of this study is to understand the experience of palliative surgery for COPD.

METHODS

Merleau-Ponty's philosophy provided a framework for this Heideggerian phenomenological inquiry. Fifty-eight semi-structured interviews were conducted with 15 patients undergoing lung volume reduction procedures and 14 family members.

RESULTS

Patients and families felt they had no option but to 'take a chance' on surgery. Interventions frequently led to regaining lost tasks or easier completion of existing tasks. Where patients did not perceive an increase in things they could 'do', surgery allowed some to reclaim their sense of self. Regardless of the outcome, most did not regret their decision for surgery.

DISCUSSION

Meanings of surgery are not always tied to the visible, objective measurements of outsiders but may relate to regaining of self. Despite the concerns of some clinicians, patients and families are more likely to accept the risk of morbidity and mortality from surgery than has previously been realized.