|
1
|
Mandizha J, Lanario JW, Duckworth A, Lines S, Paiva A, Elworthy V, Muraleedharan V, Da Ponte AJ, Shuttleworth R, Brown G, Almond H, Bond C, Cosby M, Dallas J, Naqvi M, Russell AD, Berry A, Gibbons M, Scotton CJ, Russell AM. Patient perspectives on home-spirometry in interstitial lung disease: a qualitative co-designed study. BMJ Open Respir Res 2023; 10:e001837. [PMID: 37793682 PMCID: PMC10551997 DOI: 10.1136/bmjresp-2023-001837] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/01/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Opportunities for home-monitoring are increasing exponentially. Home- spirometry is reproducible and reliable in interstitial lung disease (ILD), yet patients' experiences are not reported. Given the morbidity and mortality associated with ILDs, maintaining health-related quality-of-life is vital. We report our findings from a codesigned, qualitative study capturing the perspectives and experiences of patients using home-spirometry in a UK regional ILD National Health Service England (NHSE) commissioned service. METHODS Patients eligible for home-spirometry as routine clinical care, able to give consent and able to access a smart phone were invited to participate. In-depth, semistructured interviews were conducted at serial time points (baseline, 1, 3 and 6 months), recorded, transcribed and analysed thematically. RESULTS We report on the experiences of 10 recruited patients (8 males; median age 66 years, range 50-82 years; 7 diagnosed with idiopathic pulmonary fibrosis, 3 other ILDs) who generally found spirometry convenient and easy to use, but their relationships with forced vital capacity results were complex. Main themes emerging were: (1) anticipated benefits-to identify change, trigger action and aid understanding of condition; (2) needs-clinical oversight and feedback, understanding of results, ownership, need for data and a need 'to know'; (3) emotional impact-worry, reassurance, ambivalence/conflicting feelings, reminder of health issues, indifference; (4) ease of home-spirometry-simplicity, convenience and (5) difficulties with home-spirometry-technical issues, technique, physical effort. CONCLUSION Home-spirometry has many benefits, but in view of the potential risks to psychological well-being, must be considered on an individual basis. Informed consent and decision-making are essential and should be ongoing, acknowledging potential limitations as well as benefits. Healthcare support is vital.
Collapse
Affiliation(s)
- Jessica Mandizha
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Joseph W Lanario
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
- School of Medicine, University of Plymouth, Plymouth, UK
| | - Anna Duckworth
- Clinical & Biomedical Science, University of Exeter, Exeter, Devon, UK
| | - Sarah Lines
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Ana Paiva
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Victoria Elworthy
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Veena Muraleedharan
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Ana Jorge Da Ponte
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Rebecca Shuttleworth
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Graham Brown
- EPIC Group, University of Exeter, Exeter, Devon, UK
| | | | - Carole Bond
- EPIC Group, University of Exeter, Exeter, Devon, UK
| | - Maureen Cosby
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Joanne Dallas
- Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Marium Naqvi
- Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Alex Berry
- Academy of Nursing, University of Exeter, Exeter, Devon, UK
| | - Michael Gibbons
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | | | - Anne-Marie Russell
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
- Medical School, University of Exeter, Exeter, Devon, UK
| |
Collapse
|
|
2
|
Raghu G, Mehrotra A. Licensure laws and other barriers to telemedicine and telehealth: an urgent need for reform. THE LANCET. RESPIRATORY MEDICINE 2023; 11:11-13. [PMID: 36521508 PMCID: PMC9744441 DOI: 10.1016/s2213-2600(22)00482-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Ganesh Raghu
- Department of Medicine and Department of Laboratory Medicine and Pathology, University of Washington, Seattle 98195, WA, USA.
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| |
Collapse
|