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Efil S, Kalkan Ugurlu Y, Akça Doğan D, Budak D. Perceived Spousal Support and Activities of Daily Living in Individuals With COPD. West J Nurs Res 2024; 46:436-444. [PMID: 38655927 DOI: 10.1177/01939459241248218] [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] [Indexed: 04/26/2024]
Abstract
BACKGROUND The relationship between perceived spousal support and activities of daily living in patients with chronic obstructive pulmonary disease (COPD) is unclear. PURPOSE The aim of this study was to explore the relationship between spousal support perceived by those with COPD and their activities of daily living. METHODS This study was a cross-sectional and descriptive study. Data collection was conducted between September 2022 and April 2023. A Data Gathering Form, the Spousal Support Scale, and the London Chest Activity of Daily Living Scale were used to collect data. A total of 132 adults were included in this study. RESULTS The mean (SD) scores of individuals with COPD for perceived spousal support and activities of daily living were 62.40 (14.66) and 32.91 (15.72), respectively. Levels of perceived spousal support and activities of daily living varied according to sex, employment status, admission to the emergency service or hospitalization, use of antidepressants, and the severity of the illness (P < .05). Those with better spousal support felt less dyspnea when performing the activities of daily living (r = -0.205, P < .05). CONCLUSIONS Knowing the potential factors affecting perceived spousal support and activities of daily living can provide an opportunity to determine appropriate strategies to increase the level of independence of individuals with COPD. Educational interventions to help spouses understand COPD may help increase spousal support.
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Affiliation(s)
- Sevda Efil
- Department of Nursing, Faculty of Health Sciences, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Yasemin Kalkan Ugurlu
- Department of Internal Medicine Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey
| | - Derya Akça Doğan
- Department of Internal Medicine Nursing, Faculty of Health Sciences, Bursa Uludag University, Bursa, Turkey
| | - Dilek Budak
- Pulmonology Department, Canakkale Onsekiz Mart University Hospital, Canakkale, Turkey
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Jehloh L, Songwathana P, Kitrungrote L, Bourbonnais A. Perspectives of family caregivers and nurses on hospital discharge transitional care for Muslim older adults living with COPD: a qualitative study. BMC Nurs 2024; 23:273. [PMID: 38659051 PMCID: PMC11044287 DOI: 10.1186/s12912-024-01943-8] [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: 12/14/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The increased number of emergency department visits among older adults living with chronic obstructive pulmonary disease reflects the challenges of hospital discharge transition, especially in those from a cultural minority. The barriers and facilitators of this discharge from the perspective of formal and informal care providers, such as nurses and family caregivers, are important to identify to provide effective symptom management and quality of care. The purpose of this study was to describe the barriers and facilitators in caring for Muslim older adults with chronic obstructive pulmonary disease (COPD) during hospital discharge transitional care. METHODS A descriptive qualitative study was conducted in a hospital of Thailand where Muslim people are a cultural minority. Thirteen family caregivers of Muslim older adults living with COPD and seven nurses were purposively recruited and participated in semi-structured interviews and focus group discussions. Content analysis was used to analyze the data. RESULTS Five barriers and three facilitating factors of transitional care for Muslim older adults living with COPD were outlined. Barriers included: (1) lack of knowledge about the causes and management of dyspnea, (2) inadequate discharge preparation, (3) language barrier, (4) discontinuity of care, and (5) COVID-19 epidemic. Facilitators included: (1) the ability to understand Malayu language, (2) the presence of healthcare professionals of the same gender, and (3) the presence of Muslim healthcare providers. CONCLUSION Family caregivers require more supportive care to meet the care needs of Muslim older adults living with COPD. Alternative nurse-based transitional care programs for these older adult caregivers should be developed.
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Affiliation(s)
- Latifah Jehloh
- Faculty of Nursing, Prince of Narathiwas University, Muang, Narathiwat, Thailand
| | - Praneed Songwathana
- Faculty of Nursing, Prince of Songkla University, Hatyai, Songkhla, Thailand.
| | - Luppana Kitrungrote
- Faculty of Nursing, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Anne Bourbonnais
- Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada
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Joshi PR. Pulmonary Diseases in Older Patients: Understanding and Addressing the Challenges. Geriatrics (Basel) 2024; 9:34. [PMID: 38525751 PMCID: PMC10961796 DOI: 10.3390/geriatrics9020034] [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: 01/11/2024] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024] Open
Abstract
As the global population ages, pulmonary diseases among older people have emerged as a significant and growing public health concern. The increasing incidence of these conditions has led to higher rates of morbidity and mortality among older adults. This perspective study offers a thorough overview of the prevalent pulmonary diseases affecting the elderly demographic. It delves into the challenges encountered during the diagnosis and management of these conditions in older individuals, considering factors such as comorbidities, functional limitations, and medication complexities. Furthermore, innovative strategies and personalized interventions such as precision medicine, advanced therapies, telemedicine solutions, and patient-centered support systems aimed at enhancing the care provided to older individuals grappling with pulmonary disorders are thoroughly explored. By addressing the unique needs and complexities of this vulnerable population, healthcare systems can strive towards improving outcomes and enhancing the quality of life for elderly individuals affected by pulmonary diseases.
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Affiliation(s)
- Pushpa Raj Joshi
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
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4
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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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Madawala S, Osadnik CR, Warren N, Kasiviswanathan K, Barton C. Healthcare experiences of adults with COPD across community care settings: a meta-ethnography. ERJ Open Res 2023; 9:00581-2022. [PMID: 36755964 PMCID: PMC9900446 DOI: 10.1183/23120541.00581-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background Studies investigating lived experiences of patients with COPD raise important concerns about interactions with healthcare professionals. Patients often describe feelings of guilt and shame associated with their COPD and may experience stigma and poor patient experience of care. The aims and objectives of the present study were to systematically scope and synthesise findings from peer-reviewed qualitative studies describing healthcare experiences of patients living with COPD across community care settings. Methods A meta-ethnography was undertaken. Database searches were performed in Ovid MEDLINE, PsychINFO, Ovid Emcare, CINAHL Plus and Sociological Abstracts. Eligible qualitative studies were included. Study screening and data extraction was performed by two independent reviewers. A "line-of-argument" synthesis and deductive and inductive analysis was used to identify key themes, where the deductive element aligned to Wong and Haggerty's six key dimensions of patient experiences. Results Data from 23 studies were included. Experiences and their meaning to patients were explored within the context of six domains of patient experience including access, interpersonal communication, continuity and coordination, comprehensiveness and trust. Inductive coding revealed emotion, stigma, identity and vulnerability shaped healthcare experiences of adults with COPD. Implications Experiences often fell short of what was expected and needed in community settings. Adopting strategies to improve experiences of care in the community can be expected to improve self-management and contribute to improved health outcomes and quality of life. These strategies should take account of vulnerability, stigma and emotions such as guilt and blame that are potent affective drivers of the experience of care for patients with COPD.
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Affiliation(s)
- Sanduni Madawala
- Department of General Practice, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia,Corresponding author: Sanduni Madawala ()
| | - Christian Robert Osadnik
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Narelle Warren
- Department of Sociology, School of Social Sciences, Faculty of Arts, Monash University, Victoria, Australia
| | - Karthika Kasiviswanathan
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Chris Barton
- Department of General Practice, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
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Empowering Self-Efficacy by Using Patient Empowerment among Chronic Obstructive Pulmonary Disease: Pre-Post-Test Study. Healthcare (Basel) 2023; 11:healthcare11030430. [PMID: 36767005 PMCID: PMC9914704 DOI: 10.3390/healthcare11030430] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Patient empowerment is increasingly acknowledged as a milestone of high-quality patient-centered care. This study was conducted using COPD Self-Efficacy Scale to determine the effectiveness of the patient empowerment intervention program among chronic obstructive pulmonary disease patients on self-efficacy. We employed an interventional design with a pre-test and post-test. Sixty COPD patients comprised the final sample of the study. The current study revealed significant improvement in overall self-efficacy factors among most participants. Statistically significant positive correlations were found between the total self-efficacy post-empower intervention model scores concerning age, sex, work, educational level, and marital status. The study's findings revealed that the patient empowerment intervention program positively affected COPD patients' self-efficacy.
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Dai K, Fan X, Shi H, Xiong X, Ding L, Yu Y, Yu G, Wang S. Application of family-centered empowerment model in primary caregivers of premature infants: A quasi-experimental study. Front Pediatr 2023; 11:1137188. [PMID: 37138569 PMCID: PMC10150083 DOI: 10.3389/fped.2023.1137188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/31/2023] [Indexed: 05/05/2023] Open
Abstract
Objective To explore the effect of the family-centered empowerment model (FECM) on reducing anxiety, improving care ability, and readiness for hospital discharge of main caregivers of preterm infants. Methods The primary caregivers of preterm infants who were admitted to the Neonatal intensive care Unit (NICU) of our center from September 2021 to April 2022 were selected as the research objects. According to the wishes of the primary caregivers of preterm infants, they were divided into group A (FECM group) and group B (non-FECM group). The intervention effects were evaluated with the Anxiety Screening Scale (GAD-7), the Readiness for Hospital Discharge Scale-Parent Version (RHDS-Parent Form), and the Primary Caregivers of Premature Infants Assessment of Care Ability Questionnaire. Results Before the intervention, there was no statistically significant difference in the general information, anxiety screening, the scores of each dimension, and total score of the comprehensive ability of the main caregivers, and the score of caregiver preparedness between the two groups (P > 0.05). After the intervention, there were statistically significant differences in the anxiety screening, the total score and total score of each dimension of the care ability, and the score of caregiver preparedness between the two groups (P < 0.05). Conclusions FECM can effectively reduce the anxiety of primary caregivers of premature infants and improve their readiness for hospital discharge and care ability. To improve the quality of life of premature infants by implementing personalized training, care guidance, and peer support.
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Affiliation(s)
- Kun Dai
- Department of Public Health, Wuhan University, Wuhan, Hubei, China
- Department of Neonatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xinqi Fan
- Department of Neonatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huan Shi
- Department of Neonatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoju Xiong
- Department of Neonatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lingli Ding
- Department of Neonatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yaqi Yu
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology. Wuhan, Hubei, China
| | - Genzhen Yu
- Department of Neonatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Suqing Wang
- Department of Public Health, Wuhan University, Wuhan, Hubei, China
- Correspondence: Genzhen Yu Suqing Wang
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Loizeau V, Morvillers JM, Bertrand DP, Kilpatrick K, Rothan-Tondeur M. Defining an enabling environment for those with chronic disease: an integrative review. BMC Nurs 2021; 20:252. [PMID: 34930230 PMCID: PMC8686648 DOI: 10.1186/s12912-021-00741-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 10/08/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Health policies are currently being implemented to cope with the 37% of those affected by chronic disease and 63% of deaths worldwide. Among the proposals, there is accelerating support for greater autonomy for patients, which incorporates several concepts, including empowerment. To achieve this, develop an environment to increase an individual's capacity for action seems to be a fundamental step. The aim of this study is to characterize an enabling environment for patients in the context of chronic disease management. METHODS An integrative review design was applied. Medline, CINAHL, and Web of Science databases were searched to identify relevant literature published between 2009 and 2019. Overall, the review process was guided by the PRISMA 2020 checklist. The Mixed Methods Appraisal Tool for quality evaluation was used. RESULTS A total of 40 articles were analyzed, divided into 18 quantitative studies, 11 qualitative studies, two mixed studies, seven expert opinions, one theory and one conference report. The following characteristics defining an enabling environment were taken from the literature relating to those with a chronic condition: Needs assessment-adaptation of responses, supporting "take care", involvement in support, knowledge improvement, engagement with professionals, use of information and communication technologies, and organization of care. Beyond that, the interactions highlighted between these seven categories characterize an enabling environment. CONCLUSION This review specifies the essential elements of an enabling environment for patients with chronic conditions. It encompasses the partnership between the healthcare professional, such as the advanced practice nurse, and the individual for whom interventions and care strategies must be devised.
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Affiliation(s)
- Valérie Loizeau
- Centre Hospitalier Intercommunal Poissy Saint Germain, Université Sorbonne Paris Nord, Nursing Sciences Research Chair, Laboratory Educations and Health Practices (LEPS), (EA 3412), UFR SMBH, F-93017, Bobigny, France.
| | - Jean-Manuel Morvillers
- Research in Nursing Sciences, Health Education and Practice Laboratory (LEPS), (EA 3412), UFR SMBH, F-93017, Bobigny, France
| | | | - Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke Street West, Office 1811, Montreal, Quebec, H3A 2M7, Canada
| | - Monique Rothan-Tondeur
- Research in Nursing Sciences Tondeur, Paris, France
- Laboratoire d'Enseignements et de Pratiques de Santé (LEPS), (EA 3412), UFR SMBH, F-93017, Bobigny, France
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Welch L, Sadler E, Austin A, Rogers A. Social network participation towards enactment of self-care in people with chronic obstructive pulmonary disease: A qualitative meta-ethnography. Health Expect 2021; 24:1995-2012. [PMID: 34432927 PMCID: PMC8628589 DOI: 10.1111/hex.13340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/06/2021] [Accepted: 08/01/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND How people with chronic obstructive pulmonary disease (COPD) engage with supportive social networks to enhance self-care is not understood. The personal rationales for participation in socially directed support have not been addressed in the literature. To determine how people with COPD identify, engage and participate in socially supportive self-care practices, we conducted a systematic review and meta-ethnography of qualitative studies. METHODS A systematic literature search was conducted between June 2010 and June 2021. Of 3536 articles, 8 fulfilled the inclusion criteria. Using a meta-ethnography approach to the qualitative synthesis, new concepts were derived from the data to identify aligning themes and develop a conceptual model. FINDINGS Interpretations from the papers yielded concepts of (1) accountability and personal responsibility in self-care, (2) valued positive relationships with clinicians, (3) understanding of illness through shared and personal experiences and (4) acknowledging social networks in fostering self-care engagement in people with COPD. The independence-experience (Index) model of synthesized (third order) interpretations highlighted the processes of social networks and self-care practices: (a) fear or avoidance of dependency, (b) learning from experiences of adaptive self-care behaviours and (c) including valued practices in self-care. Self-care strategies are formed through illness experiences and relatable social encounters. CONCLUSION The model derived from the third-order interpretations is a framework to describe socially supported self-care and can be used to direct future self-care strategies and target interventions for people with COPD. PATIENT OR PUBLIC CONTRIBUTION The findings and model were presented to the long-term conditions patient and public involvement group. The manuscript is coauthored by a public representative.
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Affiliation(s)
| | - Euan Sadler
- School of Health Sciences, Faculty of Environmental and life sciencesUniversity of SouthamptonSouthamptonUK
| | - Anthony Austin
- Patient and Public Involvement Group Representative, Long Term Conditions PPI groupUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Anne Rogers
- School of Health Sciences, Faculty of Environmental and life sciencesUniversity of SouthamptonSouthamptonUK
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Lawless MT, Tieu M, Feo R, Kitson AL. Theories of self-care and self-management of long-term conditions by community-dwelling older adults: A systematic review and meta-ethnography. Soc Sci Med 2021; 287:114393. [PMID: 34534780 DOI: 10.1016/j.socscimed.2021.114393] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 02/03/2023]
Abstract
RATIONALE The proportion of older adults living with long-term conditions (LTCs) is increasing. Self-care and self-management approaches are seen as valuable in helping older people with LTCs to manage their health and care, yet the theoretical overlaps and divergences are not always clear. OBJECTIVES The objectives of this review were to: (1) systematically identify and appraise studies of self-care or self-management of LTCs by community-dwelling older adults (aged ≥60 years) either informed by, applying, creating, or testing theory; (2) explore similarities or points of convergence between the identified theories; and (3) use a meta-ethnographic approach to synthesise the theories and group related concepts into core constructs. METHODS We conducted a systematic theory synthesis, searching six electronic databases. Three reviewers independently screened titles and abstracts followed by full texts and two reviewers appraised study quality. Theoretical data were synthesised within and across individual theories using meta-ethnographic line-of-argument synthesis. RESULTS A total of 141 articles (138 studies) and 76 theories were included in the review. Seven core constructs were developed: (1) temporal and spatial context; (2) stressors; (3) personal resources; (4) informal social resources; (5) formal social resources; (6) behavioural adaptations; and (7) quality of life outcomes. A line of argument was developed that conceptualised older adults' self-care and self-management as a dynamic process of behavioural adaptation, enabled by personal resources and informal and formal social resources, aimed at alleviating the impacts of stressors and maintaining quality of life. CONCLUSION This synthesis provides an overview of theories used in research on older adults' LTC self-care and self-management. Our synthesis describes the complex interplay of intrinsic and extrinsic factors influencing self-care and self-management behaviours and provides considerations for future research, intervention design, and implementation. The utility of the constructs in research and practice requires further attention and empirical validation.
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Affiliation(s)
- Michael T Lawless
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia.
| | - Matthew Tieu
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; College of Humanities, Arts, and Social Sciences, Flinders University, Bedford Park, SA, 5042, Australia
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia
| | - Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia
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Matarese M, Pendoni R, Piredda M, De Marinis MG. Caregivers' experiences of contributing to patients' self-care in Chronic Obstructive Pulmonary Disease: A thematic synthesis of qualitative studies. J Adv Nurs 2021; 77:4017-4034. [PMID: 34245173 PMCID: PMC8518034 DOI: 10.1111/jan.14942] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/21/2021] [Accepted: 06/15/2021] [Indexed: 02/03/2023]
Abstract
Aim To identify, analyze and synthesize qualitative studies on caregivers’ experiences of contributions to the self‐care of patients with Chronic Obstructive Pulmonary Disease (COPD). Background COPD patients perform daily self‐care behaviours to manage the disease. With aging and disease progression, patients need to rely on the contributions of informal caregivers, usually family members, for disease management. Caregivers’ normal or habitual contributions to patients’ self‐care have not yet been completely investigated. Design Thematic synthesis of qualitative studies. Data sources CINAHL, EMBASE, PubMed, PsycINFO, Web of Science, Scopus, Emcare and OpenGrey databases were searched from inception to September 2020. The search was restricted to English‐language papers. Review methods Studies were critically appraised using the Critical Appraisal Skills Programme checklist. The initial line‐by‐line codes were aggregated into descriptive themes from which analytical themes were derived. Results Fifteen papers from nine countries, published 2009–2020, were included. Six analytical themes encompassing 22 descriptive themes were identified and grouped in two overarching themes describing caregivers’ experiences of contributions to patients’ self‐care during the stable and exacerbation phases of COPD. In the stable phases, caregivers contribute through maintaining disease stability, promoting healthy behaviours, fostering normal life and helping perform daily activities. During exacerbations, caregivers contribute through assessing, monitoring and managing symptoms in collaboration with patients or autonomously. They contribute by performing actions, motivating patients, organizing care, sensing variations in symptoms, acquiring knowledge and educating patients, making decisions, communicating and collaborating with healthcare providers and patients and advocating for patients. Conclusion This thematic synthesis enlarges knowledge of caregivers’ contributions to patients’ self‐care in COPD, detailing the ways by which caregivers provide care to patients. Impact Contributing daily to the self‐care of a family member with COPD is a complex experience. Nurses need to acknowledge the importance of caregivers’ contributions to patient disease management and develop effective educational interventions to support them.
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Affiliation(s)
- Maria Matarese
- Research Unit of Nursing Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Roberta Pendoni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Michela Piredda
- Research Unit of Nursing Sciences, Campus Bio-Medico University of Rome, Rome, Italy
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Abrahamsen CS, Lang-Ree HM, Halvorsen K, Stenbakken CM. Patients with COPD: Exploring patients' coping ability during an interdisciplinary pulmonary rehabilitation programme: A qualitative focus group study. J Clin Nurs 2021; 30:1479-1488. [PMID: 33555629 DOI: 10.1111/jocn.15700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 02/03/2023]
Abstract
AIMS AND OBJECTIVES To investigate experiences that contribute to enhancing patients' ability to cope with COPD during interdisciplinary in-hospital pulmonary rehabilitation programmes. BACKGROUND Patients with COPD often experience difficulties accepting their life situation as well as reduced levels of activity and social interaction. Despite the large body of research conducted on interdisciplinary collaboration and coping, few studies have examined patient perspectives of why and how pulmonary rehabilitation actually contributes to helping patients with COPD to cope with their illness. DESIGN Qualitative design. METHODS The data consist of qualitative focus group interviews with 17 participants, divided into three focus groups. The data were analysed using a thematic analysis approach. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used. RESULTS The patients described a lack of knowledge and understanding of their illness. In addition, they felt that their illness imposed limitations on their lifestyle and social interaction. Support from healthcare professionals during pulmonary rehabilitation proved to be vital, yet the lectures and consultations they received were described as general and sometimes rushed. The patients reported a positive effect from undergoing pulmonary rehabilitation, but a loss of motivation after returning home. CONCLUSION The findings indicate that gaining better health competence during pulmonary rehabilitation contributes to enhancing patients' coping ability. Moreover, patients found it valuable to meet people in a comparable situation and to feel respected by healthcare professionals. Nevertheless, taking an individual empowerment-oriented approach and focusing on the return home seem to be significant aspects of the patients' improved and lasting ability to cope after pulmonary rehabilitation. RELEVANCE TO CLINICAL PRACTICE Patients with COPD should be offered pulmonary rehabilitation because it has proven to have a positive effect on coping ability. Different follow-up measures are vital after pulmonary rehabilitation to maintain motivation after returning home.
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Affiliation(s)
- Caroline Steen Abrahamsen
- Institute of Nursing and Health promotion, Oslo Metropolitan University, Oslo, Norway.,Regional Advisory Unit for Palliative Care, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Heidi Mandt Lang-Ree
- Institute of Nursing and Health promotion, Oslo Metropolitan University, Oslo, Norway
| | - Kristin Halvorsen
- Institute of Nursing and Health promotion, Oslo Metropolitan University, Oslo, Norway
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Shiferaw KB, Tilahun BC, Endehabtu BF, Gullslett MK, Mengiste SA. E-health literacy and associated factors among chronic patients in a low-income country: a cross-sectional survey. BMC Med Inform Decis Mak 2020; 20:181. [PMID: 32762745 PMCID: PMC7407428 DOI: 10.1186/s12911-020-01202-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 07/23/2020] [Indexed: 02/03/2023] Open
Abstract
Background Chronic patients persistently seek for health information on the internet for medication information seeking, nutrition, disease management, information regarding disease preventive actions and so on. Consumers ability to search, find, appraise and use health information from the internet is known as eHealth literacy skill. eHealth literacy is a congregate set of six basic skills (traditional literacy, health literacy, information literacy, scientific literacy, media literacy and computer literacy). The aim of this study was to assess eHealth literacy level and associated factors among internet user chronic patients in North-west Ethiopia. Methods Institutional based cross-sectional study design was conducted. Stratified sampling technique was used to select 423 study participants among chronic patients. The eHealth literacy scale (eHEALS) was used for data collection. The eHEALS is a validated eight-item Likert scaled questionnaire used to asses self-reported capability of eHealth consumers to find, appraise, and use health related information from the internet to solve health problems. Statistical Package for Social science version 20 was used for data entry and further analysis. Multivariable logistic regression was used to examine the association between the eHealth literacy skill and associated factors. Significance was obtained at 95% CI and p < 0.05. Result In total, 423 study subjects were approached and included in the study from February to May, 2019. The response rate to the survey was 95.3%. The majority of respondents 268 (66.3%) were males and mean age was 35.58 ± 14.8 years. The multivariable logistic regression model indicated that participants with higher education (at least having the diploma) are more likely to possess high eHealth literacy skill with Adjusted Odds Ratio (AOR): 3.48, 95% CI (1.54, 7.87). similarly, being government employee AOR: 1.71, 95% CI (1.11, 2.68), being urban resident AOR: 1.37, 95% CI (0.54, 3.49), perceived good health status AOR: 3.97, 95% CI (1.38, 11.38), having higher income AOR: 4.44, 95% CI (1.32, 14.86), Daily internet use AOR: 2.96, 95% CI (1.08, 6.76), having good knowledge about the availability and importance of online resources AOR: 3.12, 95% CI (1.61, 5.3), having positive attitude toward online resources AOR: 2.94, 95% CI (1.07, 3.52) and higher level of computer literacy AOR: 3.81, 95% CI (2.19, 6.61) were the predictors positively associated with higher eHealth literacy level. Conclusion Besides the mounting indication of efficacy, the present data confirm that internet use and eHealth literacy level of chronic patients in this setting is relatively low which clearly implicate that there is a need to fill the skill gap in eHealth literacy among chronic patients which might help them in finding and evaluating relevant online sources for their health-related decisions.
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Affiliation(s)
- Kirubel Biruk Shiferaw
- Health Informatics Department, Medicine and Health science college, Debre Markos University, Debre Markos, Ethiopia.
| | - Binyam Chakilu Tilahun
- Health Informatics Department, College of Medicine and Health science, University of Gondar, Gondar, Ethiopia
| | - Berhanu Fikadie Endehabtu
- Health Informatics Department, College of Medicine and Health science, University of Gondar, Gondar, Ethiopia
| | - Monika Knudsen Gullslett
- Faculty of Health & Social Sciences, Science center Health & Technology, University of South-Eastern Norway, Notodden, Norway
| | - Shegaw Anagaw Mengiste
- School of Business, Institute of Business, History & Social Sciences, University of South-Eastern Norway, Notodden, Norway
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14
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Khanian ZS, Ghaffari F, Alipoor ZJ, Fotokian Z. Designing and validating the empowerment scale for the older individuals with chronic obstructive pulmonary disease (ESOCOPD). Heliyon 2020; 6:e03909. [PMID: 32405553 PMCID: PMC7210584 DOI: 10.1016/j.heliyon.2020.e03909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/01/2020] [Accepted: 04/29/2020] [Indexed: 02/03/2023] Open
Abstract
Introduction A standard scale to examine the empowerment status of older individuals with chronic obstructive pulmonary disease (COPD) can be used to assess their ability for self-care and disease management. This study aimed to design and validate the empowerment scale for the older individuals with COPD (ESOCOPD). Materials & methods This study was conducted in two phases with a deductive-inductive approach: a qualitative phase for designing the tool (the grounded theory study re-analysis, a review of texts and interviews) and a quantitative phase for validation of the questionnaire (face and content validity and reliability). Reliability was determined by test-retest and Spearman's correlation coefficient. Results Based on the results of the grounded theory study re-analysis and a review of texts and interviews, 47 items were designed, 14 of which were removed in the face and content validity assessment. The total Content validity index and content validity ratio of the questionnaire were found as 0.82 and 0.95, respectively.The final number of items in the scale was 33, and its dimensions included “information seeking, achieving independence, learning to live with COPD, participation in care, having critical thinking, psychosocial capacities management, and achieving goals”. Intra-class correlation of questionnaire dimensions was 0.86–0.99. Conclusions The ESOCOPD can be used by health care and treatment providers to determine the patient's ability for self-care and disease management because of its small number of items, it's validation, and reliability.
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Affiliation(s)
- Zahra Sam Khanian
- Student Research Committee, Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Fatemeh Ghaffari
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Jannat Alipoor
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Fotokian
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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15
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Lin SC, Chen IJ, Yu WR, Lee SYD, Tsai TI. Effect of a community-based participatory health literacy program on health behaviors and health empowerment among community-dwelling older adults: A quasi-experimental study. Geriatr Nurs 2019; 40:494-501. [PMID: 30935677 DOI: 10.1016/j.gerinurse.2019.03.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 03/13/2019] [Accepted: 03/15/2019] [Indexed: 02/07/2023]
Abstract
This study evaluated the effect of a community-based participatory health literacy program aimed at improving the health behaviors and health empowerment for older adults. A two-group pretest and posttest quasi-experimental design with surveys conducted at baseline (T1), immediately after the intervention (T2), and 6 months after the intervention (T3). The intervention group (n = 94) attended a 12-week health literacy program; while the comparison group (n = 78) did not. The results demonstrated that intervention group had significantly better health behavior practices for weight control (OR = 3.71, 95% CI = 1.59-8.64), regular exercise (OR = 15.26, 95% CI = 1.92-121.13), and health information navigation (OR = 2.61, 95% CI = 1.16-5.84). Health empowerment was significantly higher in the intervention group than the comparison group (p < 0.01).This study suggests that integrating community-based participatory design is effective in improving some health behaviors and health empowerment in older adults over a short period.
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Affiliation(s)
- Sz-Ching Lin
- School of Nursing, National Yang-Ming University, Taipei, Taiwan; Department of Nursing, Ching Kuo Institute of Management and Health, Keelung, Taiwan.
| | - I-Ju Chen
- School of Nursing, National Yang-Ming University, Taipei, Taiwan.
| | - Wen-Ry Yu
- Division of Family Medicine, Taipei City Hospital, Taipei, Taiwan.
| | - Shoou-Yih D Lee
- Department of Health Management and Policy, Faculty Lead, Griffith Leadership Center, The University of Michigan School of Public Health, USA.
| | - Tzu-I Tsai
- School of Nursing, National Yang-Ming University, Taipei, Taiwan.
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16
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Lee YS, Oh JY, Min KH, Lee SY, Kang KH, Shim JJ. The association between living below the relative poverty line and the prevalence of chronic obstructive pulmonary disease. J Thorac Dis 2019; 11:427-437. [PMID: 30962986 DOI: 10.21037/jtd.2019.01.40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Because poverty is a multifaceted concept with a complex definition, this concept may not be useful when formulating economic policy. Thus, most governments use the relative poverty line to identify poor participants who may receive economic support. The aim of this study was to investigate the association between living below the relative poverty line and the prevalence of chronic obstructive pulmonary disease (COPD). Methods We retrospectively analyzed data from 3,223 individuals included in South Korea. Living below the poverty line was defined as receiving a monthly income less than the minimum cost of living. Results Of the 3,223 participants included in this analysis, 832 (25.8%) met the definition of living below the relative poverty line and 384 (11.9%) had COPD. Of the 3,223 participants, 161 of the 832 (19.4%) living below the poverty line and 223 of the 2,391 (9.3%) living above the poverty line had COPD. In our study, participants living below the poverty line had a 1.4-time higher risk of COPD development compared with those living above the poverty line (OR =1.4; P=0.012). Elderly people living below the poverty line were 1.5-time more likely to be at risk of COPD development than those living above the poverty line (OR =1.5; P=0.021). Conclusions People living below the relative poverty line have an increased prevalence of COPD, especially older people with COPD. From the perspective of COPD disease control, policy makers should consider providing national economic support for the early detection and management of COPD in people living below the relative poverty line.
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Affiliation(s)
- Young Seok Lee
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Jee Youn Oh
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Kyung Hoon Min
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Sung Yong Lee
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Kyung Ho Kang
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Jae Jeong Shim
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
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17
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Houben-Wilke S, Augustin IM, Vercoulen JH, van Ranst D, Bij de Vaate E, Wempe JB, Spruit MA, Wouters EFM, Franssen FME. COPD stands for complex obstructive pulmonary disease. Eur Respir Rev 2018; 27:27/148/180027. [PMID: 29875138 DOI: 10.1183/16000617.0027-2018] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/16/2018] [Indexed: 02/03/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) has extensively been reported as a complex disease affecting patients' health beyond the lungs with a variety of intra- and extrapulmonary components and considerable variability between individuals. This review discusses the assessment of this complexity and underlines the importance of transdisciplinary management programmes addressing the physical, emotional and social health of the individual patient.COPD management is challenging and requires advanced, sophisticated strategies meeting the patient's individual needs. Due to the heterogeneity and complexity of the disease leading to non-linear and consequently poorly predictable treatment responses, multidimensional patient profiling is crucial to identify the right COPD patient for the right treatment. Current methods are often restricted to general, well-known and commonly used assessments neglecting potentially relevant (interactions between) individual, unique "traits" to finally ensure personalised treatment. Dynamic, personalised and holistic approaches are needed to tackle this multifaceted disease and to ensure personalised medicine and value-based healthcare.
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Affiliation(s)
| | | | - Jan H Vercoulen
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Johan B Wempe
- University Medical Center Groningen, Groningen, The Netherlands
| | - Martijn A Spruit
- CIRO+, Horn, The Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Emiel F M Wouters
- CIRO+, Horn, The Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frits M E Franssen
- CIRO+, Horn, The Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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18
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Hutchinson A, Barclay-Klingle N, Galvin K, Johnson MJ. Living with breathlessness: a systematic literature review and qualitative synthesis. Eur Respir J 2018; 51:51/2/1701477. [PMID: 29467199 DOI: 10.1183/13993003.01477-2017] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/09/2017] [Indexed: 02/03/2023]
Abstract
What is the experience of people living with breathlessness due to medical conditions, those caring for them and those treating them, with regard to quality of life and the nature of clinical interactions?Electronic databases (Ovid MEDLINE, Embase, CINAHL Plus and PsycINFO) were searched (January 1987 to October 2017; English language), for qualitative studies exploring the experience of chronic breathlessness (patients, carers and clinicians). Two independent reviewers screened titles, abstracts and papers retrieved against inclusion criteria. Disagreements were resolved with a third reviewer. Primary qualitative data were extracted and synthesised using thematic synthesis.Inclusion and synthesis of 101 out of 2303 international papers produced four descriptive themes: 1) widespread effects of breathlessness; 2) coping; 3) help-seeking behaviour; and 4) clinicians' responsiveness to the symptom of breathlessness. The themes were combined to form the concept of "breathing space", to show how engaged coping and appropriate help-seeking (patient) and attention to symptom (clinician) helps maximise the patient's quality of living with breathlessness.Breathlessness has widespread impact on both patient and carer and affects breathing space. The degree of breathing space is influenced by interaction between the patient's coping style, their help-seeking behaviour and their clinician's responsiveness to breathlessness itself, in addition to managing the underlying disease.
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19
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Russell S, Ogunbayo OJ, Newham JJ, Heslop-Marshall K, Netts P, Hanratty B, Beyer F, Kaner E. Qualitative systematic review of barriers and facilitators to self-management of chronic obstructive pulmonary disease: views of patients and healthcare professionals. NPJ Prim Care Respir Med 2018; 28:2. [PMID: 29343739 PMCID: PMC5772437 DOI: 10.1038/s41533-017-0069-z] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 02/03/2023] Open
Abstract
Self-management interventions for chronic obstructive pulmonary disease (COPD) can improve quality of life, reduce hospital admissions, and improve symptoms. However, many factors impede engagement for patients and practitioners. Qualitative research, with its focus on subjective experience, can provide invaluable insights into such factors. Therefore, a systematic review and synthesis of qualitative evidence on COPD self-management from the perspective of patients, carers, and practitioners was conducted. Following a systematic search and screening, 31 studies were appraised and data extracted for analysis. This review found that patients can adapt to COPD; however, learning to self-manage is often a protracted process. Emotional needs are considerable; frustration, depression, and anxiety are common. In addition, patients can face an assortment of losses and limitations on their lifestyle and social interaction. Over time, COPD can consume their existence, reducing motivation. Support from family can prove vital, yet tinged with ambivalence and burden. Practitioners may not have sufficient time, resources, or appropriate skills or confidence to provide effective self-management support, particularly in regard to patients' psychosocial needs. This can compound patients' capability to engage in self-management. For COPD self-management to be effective, patients' psychosocial needs must be prioritised alongside medication and exacerbation management. In addition, patients' personal beliefs regarding COPD and its management should be reviewed periodically to avoid problematic behaviours and enhance positive adaptions to the disease. Patients with COPD are not a homogenous group and no one intervention will prove effective for all. Finally, practitioners require greater education, training, and support to successfully assist patients.
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Affiliation(s)
- Siân Russell
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, USA.
| | - Oladapo J Ogunbayo
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, USA
| | - James J Newham
- Department of Primary Care & Public Health Sciences, King's College London, London, UK
| | - Karen Heslop-Marshall
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, USA
| | - Paul Netts
- NHS Newcastle Gateshead Clinical Commissioning Group, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, USA
| | - Fiona Beyer
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, USA
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, USA
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20
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Houben-Wilke S, Augustin IM, Wouters BB, Stevens RA, Janssen DJ, Spruit MA, Vanfleteren LE, Franssen FM, Wouters EF. The patient with a complex chronic respiratory disease: a specialist of his own life? Expert Rev Respir Med 2017; 11:919-924. [PMID: 29025350 DOI: 10.1080/17476348.2017.1392242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The independent and central role of the patient with a complex chronic respiratory disease in targeted, personalized disease management strategies is becoming increasingly important. Patients are the ones living with the disease and are finally responsible for their lives underlining their role as essential members of the interdisciplinary treatment team. Areas covered: The present paper narratively reviews existing research and discusses the special, as well as specialized, role of the patient with a complex chronic respiratory disease in the healthcare system and highlights fundamental elements of the (future) relationship between patient and healthcare professionals. Expert commentary: Since the chronic respiratory disease at hand is part of the patient's entire life, we need holistic, personalized approaches optimizing patients' quality of life by not only treating the disease but considering the patients' whole environment and where healthcare professionals and patients are co-creating value care.
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Affiliation(s)
| | | | - Birgit Bref Wouters
- b Department of Health, Ethics and Society, Faculty of Health , Medicine and Life Science, CAPHRI School for Public Health and Primary Care , Maastricht , The Netherlands
| | - Rosita Ah Stevens
- a Department of Research and Education , CIRO , Horn , The Netherlands
| | - Daisy Ja Janssen
- a Department of Research and Education , CIRO , Horn , The Netherlands.,c Centre of Expertise for Palliative Care , Maastricht University Medical Center , Maastricht , The Netherlands
| | - Martijn A Spruit
- a Department of Research and Education , CIRO , Horn , The Netherlands.,d Department of Respiratory Medicine , Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism , Maastricht , The Netherlands
| | - Lowie Egw Vanfleteren
- a Department of Research and Education , CIRO , Horn , The Netherlands.,e Department of Respiratory Diseases , Maastricht University Medical Center , Maastricht , The Netherlands
| | - Frits Me Franssen
- a Department of Research and Education , CIRO , Horn , The Netherlands.,e Department of Respiratory Diseases , Maastricht University Medical Center , Maastricht , The Netherlands
| | - Emiel Fm Wouters
- a Department of Research and Education , CIRO , Horn , The Netherlands.,e Department of Respiratory Diseases , Maastricht University Medical Center , Maastricht , The Netherlands
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