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Hirakawa Y, Aita K, Nishikawa M, Arai H, Miura H. Contemporary Issues and Practicalities in Completing Advance Care Planning for Patients With Severe COPD Living Alone: A Qualitative Study. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2022; 18:80-95. [PMID: 34605374 DOI: 10.1080/15524256.2021.1976353] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Health care professionals working with older people living alone with chronic obstructive pulmonary disease (COPD) to complete advance care planning (ACP) often encounter the double burden of social isolation and acute exacerbations in this planning. The study explored clinicians' perceptions regarding factors influencing the completion of ACP for older people with COPD living alone. Individual interviews were conducted with 18 health care professionals using the video meeting platform in 2020. A semi-structured interview guide included: (a) behavior and lifestyle related to decision-making, (b) desired place to die, and (c) facilitators and barriers to autonomy in patients with severe COPD who live alone. Five main themes were identified: information sharing among team members, patient readiness, desired place of death, economic constraints, and care at the time of and after death. Partly due to the heterogeneity and complexity of clinical courses and treatment responses of COPD, a wide range of social issues of a person's life were related to practicality in the completion of ACP for older people with COPD living alone. Social work knowledge and skills such as in-depth interviewing, outreach finance and welfare support, and holistic perspective play an essential role in completing ACP for COPD patients living alone.
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Affiliation(s)
- Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Kaoruko Aita
- Graduate School of Humanities and Sociology, University of Tokyo, Tokyo, Japan
| | | | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hisayuki Miura
- National Center for Geriatrics and Gerontology, Obu, Japan
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2
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Siltanen H, Aine T, Huhtala H, Kaunonen M, Paavilainen E. The information needs of people with COPD-The holistic approach with special reference to gender and time since diagnosis. Nurs Open 2021; 8:2498-2508. [PMID: 33755324 PMCID: PMC8363367 DOI: 10.1002/nop2.773] [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: 08/19/2020] [Revised: 12/07/2020] [Accepted: 12/18/2020] [Indexed: 12/12/2022] Open
Abstract
Aims The aim of this study was to determine what kinds of unmet information needs people with COPD have and whether there are differences in information needs between genders or based on the time since COPD diagnosis. Design A descriptive cross‐sectional study. Methods Data on people with COPD (N = 169) were collected from a two‐part questionnaire distributed via website. On the first part, information needs concerning the medical aspects of self‐management were measured by the Lung Information Needs Questionnaire (LINQ). On the second part, which was developed specifically for this study, a more holistic view of self‐management counselling was sought. Statistical methods were used to analyse the data. Results The respondents had wide‐ranging information needs in many areas of COPD self‐management. The most often reported areas of unmet information needs included exacerbations, diet, fatigue, stress and anxiety, palliative care and sexual life. The information needs varied by gender and time since COPD diagnosis.
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Affiliation(s)
- Hannele Siltanen
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Tiina Aine
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Heini Huhtala
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Marja Kaunonen
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Pirkanmaa Hospital District, Tampere, Finland
| | - Eija Paavilainen
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Etelä-Pohjanmaa Hospital District, Seinäjoki, Finland
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Ferrone M, Masciantonio MG, Malus N, Stitt L, O'Callahan T, Roberts Z, Johnson L, Samson J, Durocher L, Ferrari M, Reilly M, Griffiths K, Licskai CJ. The impact of integrated disease management in high-risk COPD patients in primary care. NPJ Prim Care Respir Med 2019; 29:8. [PMID: 30923313 PMCID: PMC6438975 DOI: 10.1038/s41533-019-0119-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 02/26/2019] [Indexed: 12/23/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) have a reduced quality of life (QoL) and exacerbations that drive health service utilization (HSU). A majority of patients with COPD are managed in primary care. Our objective was to evaluate an integrated disease management, self-management, and structured follow-up intervention (IDM) for high-risk patients with COPD in primary care. This was a one-year multi-center randomized controlled trial. High-risk, exacerbation-prone COPD patients were randomized to IDM provided by a certified respiratory educator and physician, or usual physician care. IDM received case management, self-management education, and skills training. The primary outcome, COPD-related QoL, was measured using the COPD Assessment Test (CAT). Of 180 patients randomized from 8 sites, 81.1% completed the study. Patients were 53.6% women, mean age 68.2 years, post-bronchodilator FEV1 52.8% predicted, and 77.4% were Global Initiative for Obstructive Lung Disease Stage D. QoL-CAT scores improved in IDM patients, 22.6 to 14.8, and worsened in usual care, 19.3 to 22.0, adjusted difference 9.3 (p < 0.001). Secondary outcomes including the Clinical COPD Questionnaire, Bristol Knowledge Questionnaire, and FEV1 demonstrated differential improvements in favor of IDM of 1.29 (p < 0.001), 29.6% (p < 0.001), and 100 mL, respectively (p = 0.016). Compared to usual care, significantly fewer IDM patients had a severe exacerbation, -48.9% (p < 0.001), required an urgent primary care visit for COPD, -30.2% (p < 0.001), or had an emergency department visit, -23.6% (p = 0.001). We conclude that IDM self-management and structured follow-up substantially improved QoL, knowledge, FEV1, reduced severe exacerbations, and HSU, in a high-risk primary care COPD population. Clinicaltrials.gov NCT02343055.
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Affiliation(s)
- Madonna Ferrone
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
- Hotel-Dieu Grace Healthcare, Windsor, ON, Canada
| | - Marcello G Masciantonio
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
- Western University, London Health Sciences Centre, London, ON, Canada
| | - Natalie Malus
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
- Western University, London Health Sciences Centre, London, ON, Canada
| | - Larry Stitt
- Lawson Health Research Institute, London, ON, Canada
| | | | - Zofe Roberts
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
| | - Laura Johnson
- Chatham Kent Family Health Team, Chatham, ON, Canada
| | - Jim Samson
- Leamington Family Health Team, Leamington, ON, Canada
| | - Lisa Durocher
- Leamington Family Health Team, Leamington, ON, Canada
| | | | | | | | - Christopher J Licskai
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada.
- Western University, London Health Sciences Centre, London, ON, Canada.
- Lawson Health Research Institute, London, ON, Canada.
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Arbillaga-Etxarri A, Gimeno-Santos E, Barberan-Garcia A, Balcells E, Benet M, Borrell E, Celorrio N, Delgado A, Jané C, Marin A, Martín-Cantera C, Monteagudo M, Montellà N, Muñoz L, Ortega P, Rodríguez DA, Rodríguez-Roisin R, Simonet P, Torán-Monserrat P, Torrent-Pallicer J, Vall-Casas P, Vilaró J, Garcia-Aymerich J. Long-term efficacy and effectiveness of a behavioural and community-based exercise intervention (Urban Training) to increase physical activity in patients with COPD: a randomised controlled trial. Eur Respir J 2018; 52:13993003.00063-2018. [PMID: 30166322 PMCID: PMC6203405 DOI: 10.1183/13993003.00063-2018] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 08/06/2018] [Indexed: 02/05/2023]
Abstract
There is a need to increase and maintain physical activity in patients with chronic obstructive pulmonary disease (COPD). We assessed 12-month efficacy and effectiveness of the Urban Training intervention on physical activity in COPD patients. This randomised controlled trial (NCT01897298) allocated 407 COPD patients from primary and hospital settings 1:1 to usual care (n=205) or Urban Training (n=202). Urban Training consisted of a baseline motivational interview, advice to walk on urban trails designed for COPD patients in outdoor public spaces and other optional components for feedback, motivation, information and support (pedometer, calendar, physical activity brochure, website, phone text messages, walking groups and a phone number). The primary outcome was 12-month change in steps·day−1 measured by accelerometer. Efficacy analysis (with per-protocol analysis set, n=233 classified as adherent to the assigned intervention) showed adjusted (95% CI) 12-month difference +957 (184–1731) steps·day−1 between Urban Training and usual care. Effectiveness analysis (with intention-to-treat analysis set, n=280 patients completing the study at 12 months including unwilling and self-reported non-adherent patients) showed no differences between groups. Leg muscle pain during walks was more frequently reported in Urban Training than usual care, without differences in any of the other adverse events. Urban Training, combining behavioural strategies with unsupervised outdoor walking, was efficacious in increasing physical activity after 12 months in COPD patients, with few safety concerns. However, it was ineffective in the full population including unwilling and self-reported non-adherent patients. Urban Training in COPD increased physical activity after 12 months but not in self-reported non-adherent patientshttp://ow.ly/dc2C30lnAEs
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Affiliation(s)
- Ane Arbillaga-Etxarri
- ISGlobal, Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Physical Activity and Sports Sciences, Faculty of Psychology and Education, University of Deusto, Donostia-San Sebastián, Spain
| | - Elena Gimeno-Santos
- ISGlobal, Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Respiratory Clinic Institute, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Anael Barberan-Garcia
- Respiratory Clinic Institute, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Eva Balcells
- Pompeu Fabra University (UPF), Barcelona, Spain.,Pneumology Dept, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.,CIBER Respiratory Diseases (CIBERES), Bunyola, Spain
| | - Marta Benet
- ISGlobal, Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Eulàlia Borrell
- Sant Roc Primary Healthcare Centre, Institut Català de la Salut (ICS), Badalona, Spain.,Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
| | | | - Anna Delgado
- ISGlobal, Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Carme Jané
- Passeig de Sant Joan Primary Healthcare Centre, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Alicia Marin
- CIBER Respiratory Diseases (CIBERES), Bunyola, Spain.,Pneumology Dept, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Carlos Martín-Cantera
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Passeig de Sant Joan Primary Healthcare Centre, Institut Català de la Salut (ICS), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Mónica Monteagudo
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Nuria Montellà
- Sant Roc Primary Healthcare Centre, Institut Català de la Salut (ICS), Badalona, Spain.,Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Laura Muñoz
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain
| | - Pilar Ortega
- Pneumology Dept, Hospital de Mataró, Mataró, Barcelona, Spain
| | - Diego A Rodríguez
- Pompeu Fabra University (UPF), Barcelona, Spain.,Pneumology Dept, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.,CIBER Respiratory Diseases (CIBERES), Bunyola, Spain
| | - Robert Rodríguez-Roisin
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pere Simonet
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Viladecans 2 Primary Healthcare Centre, Institut Català de la Salut (ICS), Viladecans, Spain.,University of Barcelona, Barcelona, Spain
| | - Pere Torán-Monserrat
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Jaume Torrent-Pallicer
- ISGlobal, Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Pere Vall-Casas
- Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Jordi Vilaró
- FCS Blanquerna, Global Research on Wellbeing (GRoW), Ramon Llull University, Barcelona, Spain
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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