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Nielsen MH, Jensen AL, Pedersen ML, Seibæk L. Living with chronic obstructive pulmonary disease or type 2 diabetes in Greenland - a qualitative interpretive description study. Int J Circumpolar Health 2024; 83:2296706. [PMID: 38127836 PMCID: PMC10763871 DOI: 10.1080/22423982.2023.2296706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Non-communicable diseases such as chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2D) represent major challenges for health systems all over the world. In an interview study, we explored patient experiences and perspectives of being diagnosed and living with COPD or T2D in Greenland. Participants (n = 24) were selected by purposeful sampling and recruited by phone. We conducted individual semi-structured interviews at the National Hospital in Nuuk and the four regional hospitals. Interviews were audio-recorded, transcribed verbatim, and analysed using interpretive description. Three themes emerged: shock and shame on receiving the diagnosis, coping with a changed life, and varying needs for care and communication. We found that being diagnosed with COPD or T2D required a rapid change in the participants' everyday lives and lifestyle behaviours. Some self-managed their disease well and were able to transfer their knowledge and integrate it into their daily lives, while others struggled to make lifestyle changes. Additionally, living with COPD or T2D could be related to silence and shame. The findings contribute to a better understanding of living with COPD or T2D in the Arctic region and the development of future, culturally-adapted patient education initiatives.
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Affiliation(s)
- Maja Hykkelbjerg Nielsen
- Queen Ingrid’s Hospital, Steno Diabetes Center Greenland, Nuuk, Greenland
- Greenland Center for Health Research, Department of Health and Nature, Ilisimatusarfik/University of Greenland, Nuuk, Greenland
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Annesofie Lunde Jensen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Lynge Pedersen
- Queen Ingrid’s Hospital, Steno Diabetes Center Greenland, Nuuk, Greenland
- Greenland Center for Health Research, Department of Health and Nature, Ilisimatusarfik/University of Greenland, Nuuk, Greenland
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lene Seibæk
- Greenland Center for Health Research, Department of Health and Nature, Ilisimatusarfik/University of Greenland, Nuuk, Greenland
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
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Mudzingwa IT, Ayton JE. Acceptability of a peer-led self-management program for people living with chronic obstructive pulmonary disease in regional Southern Tasmania in Australia: A qualitative study. Chronic Illn 2024; 20:96-104. [PMID: 36895141 PMCID: PMC10865749 DOI: 10.1177/17423953231163450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/16/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES People living with chronic obstructive pulmonary disease (COPD) in regional communities experience a higher disease burden and have poorer access to support services. This study sought to investigate the acceptability of a peer-led self-management program (SMP) in regional Tasmania, Australia. METHODS This descriptive qualitative study, underpinned by interpretivism used semi-structured one-to-one interviews to gather data to explore COPD patients' views of peer-led SMPs. Purposeful sampling recruited a sample of 8 women and 2 men. Data was analysed using a thematic approach. RESULTS The three final themes, 'Normality and Living with the disease', a 'Platform for sharing' and 'Communication mismatch' suggest that peer-led SMPs could offer an opportunity to share experiences. The themes also suggest that COPD often manifested as a deviation from 'normal life'. Communication was often felt to be ambiguous leading to tension between the health experts and people living with the condition. DISCUSSION Peer-led SMP has the potential to provide the much-needed support for people living with COPD in regional communities. This will ensure that they are empowered to live with the condition with dignity and respect. Benefits of exchanging ideas and socialisation should not be ignored and may enhance sustainability of SMPs.
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Affiliation(s)
| | - Jennifer E Ayton
- Tasmanian School of Medicine College of Health and Medicine, University of Tasmania, Hobart, Australia
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Ekdahl A, Söderberg S, Holmström Rising M. Being met as a person and not as a diagnosis - Meanings of healthcare encounters for women with chronic obstructive pulmonary disease stage III or IV. Health Care Women Int 2024:1-13. [PMID: 38334989 DOI: 10.1080/07399332.2024.2310068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/19/2024] [Indexed: 02/10/2024]
Abstract
Our study seeks to elucidate meanings of healthcare encounters for women with chronic obstructive pulmonary disease stage III or IV. We conducted 12 narrative interviews which were analyzed using phenomenological hermeneutic interpretation. Our analysis revealed one theme; being met as a person and not as a diagnosis with three subthemes: getting sufficient time and feeling involved in care; fulfillment of personal needs; and experiencing disrespect and injustice. We found that meanings of healthcare encounters center on the expectation of being seen as a person. Feeling disrespected and injust leaves women unsupported and could pose serious health risks.
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Affiliation(s)
- Ann Ekdahl
- Department of Health Sciences, Mid Sweden University, Sweden
| | - Siv Söderberg
- Department of Health Sciences, Mid Sweden University, Sweden
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4
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Paige SR, Krieger JL, Williams M, Salloum RG. Patient message preferences to promote clinical conversations about chronic obstructive pulmonary disease (COPD): A discrete choice experiment. PEC INNOVATION 2023; 2:100168. [PMID: 37384164 PMCID: PMC10294043 DOI: 10.1016/j.pecinn.2023.100168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/21/2023] [Accepted: 05/21/2023] [Indexed: 06/30/2023]
Abstract
The purpose of this study was to identify message features that motivate patients to initiate clinical conversations about Chronic Obstructive Pulmonary Disease (COPD). A secondary aim was to determine whether preferred message features vary by socio-demographic and behavioral characteristics. A discrete choice experiment was conducted in August 2020. Participants were asked to select which messages would motivate them to speak with a clinician about COPD. This included selecting messages across 8 choice sets, or a systematic combination of messages reflecting 6 attributes (e.g., susceptibility, call-to-action, emotion-frame, efficacy, message source, organizational support). The final sample was 928, which included adults (M = 62.07; SD = 10.14 years old) who identified as non-Hispanic, white, and with at least some college experience. Message attributes ranked from most to least important were COPD susceptibility (25.53% [95% CI = 24.39, 26.66]), message source (19.32% [95% CI = 18.41-20.24]), COPD organization logo (19.13%; [95% CI = 18.26, 20.01]), call-to-action (14.12%; [95% CI = 13.40, 14.85], emotion-frame (13.24% [95% CI = 12.55-13.94]), and efficacy (8.65%; [95% CI = 8.20-9.09]). Participants preferred susceptibility messages about COPD signs/symptoms rather than risk behaviors related to smoking tobacco and environmental exposures. They also preferred messages from medical authorities (i.e., clinicians, COPD organization), a call-to-action that supports their autonomy in screening decision-making, and a message that conveys hope for living a healthy life with COPD and builds their self-efficacy to get screened. Differences in message preferences were detected according to age, gender, race, ethnicity, education level, and current vs. former smoking status. This study identified message features that motivate clinical conversations about COPD, especially those from subgroups who are disproportionately at-risk for its late-stage diagnosis.
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Affiliation(s)
- Samantha R. Paige
- STEM Translational Communication Center, University of Florida, Gainesville, FL 32611, USA
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
- Health & Wellness Solutions, Johnson & Johnson Services, Inc., New Brunswick, NJ 08933, USA
| | - Janice L. Krieger
- STEM Translational Communication Center, University of Florida, Gainesville, FL 32611, USA
| | - Maribeth Williams
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Ramzi G. Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
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Christiansen CF, Løkke A, Bregnballe V, Prior TS, Farver-Vestergaard I. COPD-Related Anxiety: A Systematic Review of Patient Perspectives. Int J Chron Obstruct Pulmon Dis 2023; 18:1031-1046. [PMID: 37304765 PMCID: PMC10257401 DOI: 10.2147/copd.s404701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023] Open
Abstract
Background Anxiety in patients with chronic obstructive pulmonary disease (COPD) is prevalent but often unidentified and therefore not adequately managed. Clinicians find it difficult to detect anxiety symptoms and to differentiate subclinical anxiety from anxiety disorders, because of the considerable overlap between symptoms of COPD and anxiety. Purpose We synthesized existing qualitative research on patients' experiences of COPD-related anxiety with the purpose of gaining a richer understanding and proposing a model of the construct. Methods Searches for qualitative studies of patients' experiences of COPD-related anxiety were conducted independently by two authors in the databases of PubMed (MEDLINE), CINAHL (EBSCO), and PsycInfo (APA). English-language studies including patients diagnosed with COPD were reviewed, and data were analyzed using thematic analysis. Results A total of 41 studies were included in the review. Four themes related to COPD-related anxiety were identified: initial events; internal maintaining factors; external maintaining factors; and behavioral maintaining factors. Based on the identified four themes, a conceptual model of COPD-related anxiety from the patient perspective was developed. Conclusion A conceptual model of COPD-related anxiety from the patient perspective is now available, with the potential to inform future attempts at improving identification and management of COPD-related anxiety. Future research should focus on the development of a COPD-specific anxiety questionnaire containing domains that are relevant from the patient perspective.
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Affiliation(s)
- Camilla F Christiansen
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anders Løkke
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Thomas Skovhus Prior
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Ingeborg Farver-Vestergaard
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Social dimensions of chronic respiratory disease: stigma, isolation, and loneliness. Curr Opin Support Palliat Care 2022; 16:195-202. [PMID: 36102929 DOI: 10.1097/spc.0000000000000616] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW Social wellbeing is a core component of heath. However, people with chronic respiratory disease report unmet social needs, particularly in relation to stigma, social isolation, and loneliness. This review considers recent advances in understanding these social concepts within the context of chronic respiratory disease. RECENT FINDINGS A growing body of qualitative work illustrates the detrimental impacts of stigma in chronic respiratory disease, contributing towards poorer psychological health and self-management, and reduced engagement with professional support. Stigma, alongside physical limitations stemming from respiratory symptoms, can also contribute to social isolation and loneliness. Social isolation and loneliness are associated with poorer mental health and quality of life, declines in function, and in some cases, increased hospital admissions. Although close or cohabiting relationships can ameliorate some social challenges, isolation and loneliness can also impact informal carers of people with chronic respiratory disease. SUMMARY Increasing evidence illustrates the direct and indirect influences of social dimensions on health outcomes for people living with chronic respiratory disease. Although there is increased understanding of the lived experiences of stigma, less is understood about the complexities of social isolation and loneliness in chronic respiratory disease, and optimal interventions to address social challenges.
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Tian J, Zhou F, Zhang XG, Wang HY, Peng SH, Li X, Cao J, Zhang H. Experience of physical activity in patients with COPD: A systematic review and qualitative meta-synthesis. Geriatr Nurs 2022; 47:211-219. [PMID: 35940039 DOI: 10.1016/j.gerinurse.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To systematically evaluate and integrate the qualitative research on physical activity (PA) experience of patients with chronic obstructive pulmonary disease (COPD). METHODS Web of Science, Cochrane Library, Embase, CINAHL and other databases were searched, and the qualitative research on PA experience of patients with COPD was collected. The systematic review was conducted in line with Joanna Briggs Institute (JBI) methodology for systematic reviews of qualitative evidence. RESULTS 12 studies were included and 3 themes were summarized, included: COPD patients experience more barriers while participating in physical activities than facilitators; COPD patients experience more positive effects post-physical activities than negative effects; Guaranteeing safety, goal setting, and establishing a professional support group improve compliance in COPD patients. CONCLUSION Health care professionals should help patients overcome the obstacles of PA, pay attention to the PA experience of patients, adopt diversified PA methods, improve PA participation and compliance, and make patients develop good PA habits.
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Affiliation(s)
- Jing Tian
- College of Nursing,Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
| | - Fan Zhou
- College of Nursing,Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
| | - Xian Geng Zhang
- Sichuan Nursing Vocational College, No.173 Longdu South Road, Longquanyi District, Chengdu, Sichuan 610100, China.
| | - Hong Yan Wang
- Sichuan Nursing Vocational College, No.173 Longdu South Road, Longquanyi District, Chengdu, Sichuan 610100, China
| | - Si Han Peng
- Affiliated hospital of Chengdu University of Traditional Chinese Medicine,Chengdu, Sichuan 610032, China
| | - Xin Li
- College of Nursing,Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
| | - Jun Cao
- Sichuan Nursing Vocational College, No.173 Longdu South Road, Longquanyi District, Chengdu, Sichuan 610100, China
| | - Hong Zhang
- College of Nursing,Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
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Bernstein E, Bade BC, Akgün KM, Rose MG, Cain HC. Barriers and facilitators to lung cancer screening and follow-up. Semin Oncol 2022; 49:S0093-7754(22)00058-6. [PMID: 35927099 DOI: 10.1053/j.seminoncol.2022.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022]
Abstract
Two randomized trials have shown that lung cancer screening (LCS) with low dose computed tomography (LDCT) reduces lung cancer mortality in patients at high-risk for lung malignancy by identifying early-stage cancers, when local cure and control is achievable. The implementation of LCS in the United States has revealed multiple barriers to preventive cancer care. Rates of LCS are disappointingly low with estimates between 5%-18% of eligible patients screened. Equally concerning, follow-up after baseline screening is far lower than that of clinical trials (44-66% v >90%). To optimize the benefits of LCS, programs must identify and address factors related to LCS participation and follow-up while concurrently recognizing and mitigating barriers. As a relatively new screening test, the most effective processes for LCS are uncertain. Therefore, LCS programs have adopted a wide range of approaches without clearly established best practices to guide them, particularly in rural and resource-limited settings. In this narrative review, we identify barriers and facilitators to LCS, focusing on those studies in non-clinical trial settings - reflecting "real world" challenges. Our goal is to identify effective and scalable LCS practices that will increase LCS participation, improve adherence to follow-up, inform strategies for quality improvement, and support new research approaches.
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Affiliation(s)
- Ethan Bernstein
- Veterans Administration (VA) Connecticut Healthcare System, Section of Pulmonary, Critical Care, and Sleep Medicine, West Haven, CT, USA; Yale School of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA
| | - Brett C Bade
- Veterans Administration (VA) Connecticut Healthcare System, Section of Pulmonary, Critical Care, and Sleep Medicine, West Haven, CT, USA; Yale School of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA; Veterans Administration (VA) Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities, and Education Center, West Haven, CT, USA
| | - Kathleen M Akgün
- Veterans Administration (VA) Connecticut Healthcare System, Section of Pulmonary, Critical Care, and Sleep Medicine, West Haven, CT, USA; Yale School of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA; Veterans Administration (VA) Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities, and Education Center, West Haven, CT, USA
| | - Michal G Rose
- Veterans Administration (VA) Connecticut Healthcare System, Section of Hematology/Oncology, West Haven, CT, USA; Yale School of Medicine, Section of Medical Oncology, New Haven, CT, USA
| | - Hilary C Cain
- Veterans Administration (VA) Connecticut Healthcare System, Section of Pulmonary, Critical Care, and Sleep Medicine, West Haven, CT, USA; Yale School of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA.
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Lundell S, Toots A, Sönnerfors P, Halvarsson A, Wadell K. Participatory methods in a digital setting: experiences from the co-creation of an eHealth tool for people with chronic obstructive pulmonary disease. BMC Med Inform Decis Mak 2022; 22:68. [PMID: 35303895 PMCID: PMC8932463 DOI: 10.1186/s12911-022-01806-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/11/2022] [Indexed: 12/22/2022] Open
Abstract
Background Using participatory methods to engage end-users in the development and design of eHealth is important to understand and incorporate their needs and context. Within participatory research, recent social distancing practice has forced a transition to digital communication platforms, a setting that warrants deeper understanding. The aim of this study was to describe the experiences of, and evaluate a digital co-creation process for developing an eHealth tool for people with chronic obstructive pulmonary disease (COPD). Methods The co-creation was guided by Participatory appreciative action and reflection, where a convenience sample (n = 17), including persons with COPD, health care professionals, relatives and a patient organization representative participated in six digital workshops. User instructions, technical equipment, and skilled support were provided if necessary. Workshops centred around different topics, with pre-recorded films, digital lectures and home assignments to up-skill participants. Process validity, experiences and ownership in the co-creation process were evaluated by repeated respondent validation, member checking, questionnaires and by assessing attendance. Data was analysed quantitatively or qualitatively as appropriate. Results The co-creators were in general satisfied with the digital format of the workshops. Mean attendance and perceived engagement in workshops was high and the experience described as enjoyable. Engagement was facilitated by up-skilling activities and discussions in small groups. Few had used digital communication previously, and feelings ranging from excitement to concern were expressed initially. Technical issues, mainly audio related, were resolved with support. At completion, skills using equipment and digital platform surpassed expectations. Few disadvantages with the digital format were identified, and advantages included reduced travel, time efficiency and reduced infection risk. Conclusions Experiences of digital co-creation were overwhelmingly positive, despite initial barriers related to computer naivety and use of digital equipment and platforms. The high level of satisfaction, engagement, attendance rates, and agreement between individual and group views suggests that a digital co-creation process is a feasible method. Several important success factors were identified, such as the provision of information and education on discussion topics in advance of workshops, as well as the smaller group discussions during workshops. The knowledge gained herein will be useful for future digital co-creation processes.
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Affiliation(s)
- Sara Lundell
- Department of Community Medicine and Rehabilitation, Umeå University, 901 87, Umeå, Sweden.
| | - Annika Toots
- Department of Community Medicine and Rehabilitation, Umeå University, 901 87, Umeå, Sweden
| | - Pernilla Sönnerfors
- Division of Physiotherapy, Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Alexandra Halvarsson
- Division of Physiotherapy, Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Wadell
- Department of Community Medicine and Rehabilitation, Umeå University, 901 87, Umeå, Sweden
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Criner GJ, Cole T, Hahn KA, Kastango K, Eudicone JM, Gilbert I. Use of a Digital Chronic Obstructive Pulmonary Disease Respiratory Tracker in a Primary Care Setting: A Feasibility Study. Pulm Ther 2021; 7:533-547. [PMID: 34463947 PMCID: PMC8589940 DOI: 10.1007/s41030-021-00168-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/29/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Telemonitoring is a promising self-management strategy to improve health care outcomes. This study evaluated real-world adoption of the chronic obstructive pulmonary disease (COPD) Co-Pilot daily symptom monitoring tool by patients and primary care providers (PCPs). Methods An open-label, 6-month, single-arm, multicenter, noninterventional feasibility study enrolled 97 patients aged ≥ 40 years with symptomatic or poorly controlled COPD and ≥ 10 pack-year smoking history. Patients received smartphones and training to use the COPD Co-Pilot application. During the study, patients tracked symptoms daily; an increase in symptom score of ≥ 1.0 point from baseline (symptom alert) prompted patients to contact their PCP via toll-free number. The primary endpoint was time to clinical recommendation (TTCR) from a symptom alert; adherence to completing daily symptom reports through the COPD Co-Pilot application and patient satisfaction were also measured. Results Overall, 87 of 96 patients (90.6%) received 2142 symptom alerts; 42 alerts (equivalent to 2% of all symptom alerts) resulted in 23 patients contacting their PCP. Median TTCR was 7.1 h (interquartile range [IQR]: 4.0–29.9). Among 15 patients using the toll-free number, median TTCR was 2.1 h (IQR 0.0–7.2) versus 19.6 h (IQR 4.5–45.2) for eight patients using other contact methods. Average COPD Co-Pilot adherence overall was 75.2% (95% CI 74.6–75.9). Patients responded favorably regarding the application’s ease of use, functionality, and information provided. Conclusions The COPD Co-Pilot tool was associated with relatively high levels of adherence, suggesting patients’ willingness to monitor symptoms daily. Although a limited number of patients initiated PCP contact, patients who used the study-provided toll-free number had substantially shorter median TTCR, suggesting that this tool could help empower patients to better manage their COPD. Supplementary Information The online version contains supplementary material available at 10.1007/s41030-021-00168-3.
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Affiliation(s)
- Gerard J Criner
- Temple University Hospital, Philadelphia, PA, USA. .,Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine At Temple University, 3500 North Broad Street, Philadelphia, PA, 19140, USA.
| | - Therese Cole
- IQVIA, Rockville, MD, USA.,Advanced Clinical, Deerfield, IL, USA
| | | | - Kari Kastango
- IQVIA, Cambridge, MA, USA.,Everest Clinical Research, Little Falls, NJ, USA
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Pullen R, Miravitlles M, Sharma A, Singh D, Martinez F, Hurst JR, Alves L, Dransfield M, Chen R, Muro S, Winders T, Blango C, Muellerova H, Trudo F, Dorinsky P, Alacqua M, Morris T, Carter V, Couper A, Jones R, Kostikas K, Murray R, Price DB. CONQUEST Quality Standards: For the Collaboration on Quality Improvement Initiative for Achieving Excellence in Standards of COPD Care. Int J Chron Obstruct Pulmon Dis 2021; 16:2301-2322. [PMID: 34413639 PMCID: PMC8370848 DOI: 10.2147/copd.s313498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/30/2021] [Indexed: 12/17/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) are managed predominantly in primary care. However, key opportunities to optimize treatment are often not realized due to unrecognized disease and delayed implementation of appropriate interventions for both diagnosed and undiagnosed individuals. The COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST) is the first-of-its-kind, collaborative, interventional COPD registry. It comprises an integrated quality improvement program focusing on patients (diagnosed and undiagnosed) at a modifiable and higher risk of COPD exacerbations. The first step in CONQUEST was the development of quality standards (QS). The QS will be imbedded in routine primary and secondary care, and are designed to drive patient-centered, targeted, risk-based assessment and management optimization. Our aim is to provide an overview of the CONQUEST QS, including how they were developed, as well as the rationale for, and evidence to support, their inclusion in healthcare systems. Methods The QS were developed (between November 2019 and December 2020) by the CONQUEST Global Steering Committee, including 11 internationally recognized experts with a specialty and research focus in COPD. The process included an extensive literature review, generation of QS draft wording, three iterative rounds of review, and consensus. Results Four QS were developed: 1) identification of COPD target population, 2) assessment of disease and quantification of future risk, 3) non-pharmacological and pharmacological intervention, and 4) appropriate follow-up. Each QS is followed by a rationale statement and a summary of current guidelines and research evidence relating to the standard and its components. Conclusion The CONQUEST QS represent an important step in our aim to improve care for patients with COPD in primary and secondary care. They will help to transform the patient journey, by encouraging early intervention to identify, assess, optimally manage and followup COPD patients with modifiable high risk of future exacerbations.
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Affiliation(s)
- Rachel Pullen
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Marc Miravitlles
- Pneumology Dept, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Anita Sharma
- Platinum Medical Centre, Chermside, QLD, Australia
| | - Dave Singh
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - Fernando Martinez
- New York-Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Luis Alves
- EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Mark Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rongchang Chen
- Key Laboratory of Respiratory Disease of Shenzhen, Shenzhen Institute of Respiratory Disease, Shenzhen People’s Hospital (Second Affiliated Hospital of Jinan University, First Affiliated Hospital of South University of Science and Technology of China), Shenzhen, People's Republic of China
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Tonya Winders
- USA & Global Allergy & Airways Patient Platform, Vienna, Austria
| | - Christopher Blango
- Janssen Pharmaceutical Companies of Johnson & Johnson, Philadelphia, PA, USA
| | | | | | | | | | | | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Amy Couper
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Rupert Jones
- Research and Knowledge Exchange, Plymouth Marjon University, Plymouth, UK
| | - Konstantinos Kostikas
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Respiratory Medicine Department, University of Ioannina School of Medicine, Ioannina, Greece
| | - Ruth Murray
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Woo S, Zhou W, Larson JL. Stigma Experiences in People with Chronic Obstructive Pulmonary Disease: An Integrative Review. Int J Chron Obstruct Pulmon Dis 2021; 16:1647-1659. [PMID: 34113096 PMCID: PMC8187000 DOI: 10.2147/copd.s306874] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background People with chronic obstructive pulmonary disease (COPD) are stigmatized by smoking history. Although little is known about COPD-related stigma, it can adversely affect self-management and quality of life. Objective To synthesize relevant scientific literature exploring stigma experiences and their impacts on people with COPD. Methods CINAHL/PsycINFO/PubMed/Scopus were searched for relevant studies. Findings were organized using Major et al’s conceptual model. Results Fifteen studies documented COPD-related stigma processes: enacted, felt, internalized, and anticipated. Moderating factors included visibility, origin, and illness perception. Individual-level stigma responses included emotional distress, limited social interactions, and negative effects on medication adherence and help-seeking. Social/community-level stigma experiences included healthcare provider and employer behaviors. Smoking is interwoven throughout all domains of stigma processes and responses to stigma. Conclusion Substantial evidence documents processes, moderating factors, and individual and social/community responses to the complex phenomenon of COPD-related stigma; however, prevalence of COPD-related stigma and its health effects are unclear.
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Affiliation(s)
- Seoyoon Woo
- University of North Carolina Wilmington, School of Nursing, Wilmington, NC, 28403-5995, USA
| | - Weijiao Zhou
- University of Michigan, School of Nursing, Ann Arbor, MI, 48109, USA
| | - Janet L Larson
- University of Michigan, School of Nursing, Ann Arbor, MI, 48109, USA
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Jerpseth H, Knutsen IR, Jensen KT, Halvorsen K. Mirror of shame: Patients experiences of late-stage COPD. A qualitative study. J Clin Nurs 2021; 30:2854-2862. [PMID: 33934413 DOI: 10.1111/jocn.15792] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES This study aims to shed light on patients with late-stage COPD and their experiences of shame. BACKGROUND Patients with COPD often experience shame for bringing the disease into their lives due to smoking. Knowledge about patients with COPD and their feelings of shame is crucial, but limited, however. DESIGN The study has a qualitative and explorative design. We interviewed twelve patients with late-stage COPD. The data were analysed using Kvale and Brinkmann's three interpretative contexts. The COREQ checklist was used. RESULTS Three main themes were defined; the body as a mirror of shame; a sense of being unworthy, invisible and powerless; and that sharing the burden is too difficult. The participants experienced that the disease defined their value as human beings and that made them feel vulnerable, ashamed and more socially isolated. CONCLUSIONS The participants experienced feelings of shame, guilt and self-blame due to their own perceptions of themselves. They were in doubt about whether they were worthy to receive care and comfort from both health professionals and, their family and friends. The participants seemed to have internalised the moral norms of contemporary society and the understanding that the disease, and especially a 'self-inflicted' disease, is a personal weakness. RELEVANCE FOR CLINICAL PRACTICE Findings from this study show that patients struggle with feelings such as shame and misery. The nurses who work bedside are in continuous contact with the patients and have an opportunity to gain knowledge of these feelings in order to meet the patients' needs for comfort and care. They have an obligation to ask patients about their feelings and meet them with empathy and respect. Moreover, it is necessary to have interdisciplinary fora in clinical practice where health professionals reflect, discuss and challenge themselves according to attitudes towards patients with so-called 'self-inflicted' diseases.
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Affiliation(s)
- Heidi Jerpseth
- Faculty of Health Science, Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Ingrid R Knutsen
- Faculty of Health Science, Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Kari T Jensen
- Institute of Nursing and Health Promotion, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
| | - Kristin Halvorsen
- Faculty of Health Science, Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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