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RESEARCH QUESTION: From the perspectives of healthcare professionals (HCPs) and people with chronic obstructive pulmonary disease (COPD) known to tertiary care, what influences successful referrals to a pulmonary rehabilitation program (PRP)? METHODS: This cross-sectional qualitative study was informed by a critical realist perspective. We purposively sampled people with COPD and HCPs who deliver COPD care and used semi-structured interviews and focus groups to explore determinants of a successful referral to a PRP. Interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis. RESULTS: Data were available on 38 HCPs and 15 people with COPD. We generated three core themes pertaining to successful referrals. The first theme was that HCPs should be mindful of how professional responsibilities (such as their personal value and interest in a PRP, their degree of understanding of PRPs, and the organisational culture the PRPs are embedded within) shape decision-making during a therapeutic interaction. The second theme, there's more to me than my COPD, characterised psychological perceptions that shape a person's readiness to engage in a PRP. The third theme, communication is a two-way street that requires careful navigation, characterised the interpersonal dynamic between HCP and patient, and how dedicated conversations about PRPs can encourage successful referrals. CONCLUSION: Therapeutic interactions that include dedicated conversations about PRPs can foster successful referrals among people with COPD. During these interactions, HCPs should take the time to understand and carefully unpack psychological perceptions whilst imparting value, interest and enthusiasm for PRPs. Doing so can shape patient engagement toward referral success.
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Comunicación , Participación del Paciente , Enfermedad Pulmonar Obstructiva Crónica , Investigación Cualitativa , Derivación y Consulta , Humanos , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Enfermedad Pulmonar Obstructiva Crónica/psicología , Estudios Transversales , Masculino , Participación del Paciente/psicología , Femenino , Persona de Mediana Edad , Anciano , Grupos Focales , Personal de Salud/psicología , Toma de Decisiones , AdultoRESUMEN
Objectives: This study aimed to investigate the dynamic patterns of perception and expectations among COPD patients. Methods: Conducted at the Heart-Respiratory Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, in Milan, Italy, the research involved 28 participants (16 males; mean age 72.8 ± 9.9) in face-to-face interviews. Utilizing a Grounded Theory approach, complemented by clinical data, recorded, and transcribed interviews underwent enhancement through the integration of two pictorial tools. Results: The central theme that emerged was a profound sense of responsibility toward their condition, perceived as a significant threat to life. Key symptoms, such as shortness of breath, coupled with negative expectations about their condition, contributed to depressive mood and avoidance behaviors. A notable proportion (N = 17; 60.71%) of participants struggled to envision a positive future, expressing a pervasive sense of hopelessness, which significantly influenced their health behaviors and adherence to medical recommendations. Conversely, individuals who felt supported and optimistic about treatment efficacy exhibited more positive expectations and adopted proactive coping strategies. Discussion: Recognizing the dynamic nature of patients' perceptions and negative illness expectations is essential to create personalized therapeutic interventions and meet the specific needs of COPD patients, ultimately improving the overall effectiveness of their care journey.
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Adaptación Psicológica , Teoría Fundamentada , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Enfermedad Pulmonar Obstructiva Crónica/psicología , Enfermedad Pulmonar Obstructiva Crónica/terapia , Masculino , Femenino , Anciano , Persona de Mediana Edad , Depresión/psicología , Depresión/etiología , Anciano de 80 o más Años , Disnea/psicología , Disnea/etiología , Disnea/terapia , Investigación Cualitativa , Medicina de Precisión/métodos , Actitud Frente a la Salud , Conductas Relacionadas con la Salud , Percepción , Entrevistas como AsuntoRESUMEN
Objective: To describe the perspectives of a group of COPD patients during the first outbreak of the COVID-19 pandemic and narrate the emotions and polarity (acceptance-rejection) regarding living with COPD during the pandemic. Design/methods: We used a novel application of lemmatization and thematic analysis of participants' narratives. A study was carried out with eight patients with moderate-severe-very severe COPD during the first outbreak of COVID-19 using purposive sampling. In-depth interviews and field notes from the researchers were used to collect data. A statistical content analysis (lemmatization) of the patients' narratives was performed. Additionally, inductive thematic analysis was used to identify emerging themes. This study was conducted following the guidelines of Consolidated Criteria/Standards for Reporting Qualitative Research. The study was conducted in accordance with the principles articulated in the WMA Declaration of Helsinki. Participants provided verbal informed consent prior to their inclusion as previously described. Results: The average age of our sample was 65 years, and 75% of the patients suffered from moderate COPD, 12.5% from severe COPD, and 12.5% from very severe COPD according to GOLD criteria. The lemmatized and sentiment analysis showed a predominance of positive emotions, and the polarity of the interviews indicated a very slight positive trend towards acceptance of the experience lived during the pandemic. Additionally, three main themes were identified: (1) Confinement and restriction measures, (2) COVID-19 and protective measures, and (3) Clinical care during the first outbreak of the pandemic. Conclusion: Patients experienced confinement with a feeling of security and protection. They strictly respect social distancing. They used masks, but these caused them to feel short of breath and fatigue, especially FFP2 masks. Half of the patients rejected the possibility of being vaccinated. Finally, they were very satisfied with the clinical care they received in the COPD unit of their hospital. Our results show that COPD patients have not experienced a negative impact of the COVID-19 pandemic.
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COVID-19 , Enfermedad Pulmonar Obstructiva Crónica , Investigación Cualitativa , Humanos , COVID-19/psicología , COVID-19/epidemiología , COVID-19/prevención & control , Enfermedad Pulmonar Obstructiva Crónica/psicología , Masculino , Anciano , Femenino , Persona de Mediana Edad , SARS-CoV-2 , Pandemias , Entrevistas como Asunto , EmocionesRESUMEN
BACKGROUND: Computerized adaptive testing (CAT) is an effective way to reduce time, repetitious redundancy, and respond burden, and has been used to measure outcomes in many diseases. This study aimed to develop and validate a comprehensive disease-specific CAT for chronic obstructive pulmonary disease (COPD) patient-reported outcome measurement. METHODS: The discrimination and difficulty of the items from the modified patient-reported outcome scale for COPD (mCOPD-PRO) were analyzed using item response theory. Then the initial item, item selection method, ability estimation method, and stopping criteria were further set based on Concerto platform to form the CAT. Finally, the reliability and validity were validated. RESULTS: The item discrimination ranged from 1.05 to 2.71, and the item difficulty ranged from - 3.08 to 3.65. The measurement reliability of the CAT ranged from 0.910 to 0.922 using random method, while that ranged from 0.910 to 0.924 using maximum Fisher information (MFI) method. The content validity was good. The correlation coefficient between theta of the CAT and COPD assessment test and modified Medical Research Council dyspnea scale scores using random method was 0.628 and 0.540 (P < 0.001; P < 0.001) respectively, while that using MFI method was 0.347 and 0.328 (P = 0.007; P = 0.010) respectively. About 11 items (reducing by 59.3%) on average were tested using random method, while about seven items (reducing by 74.1%) on average using MFI method. The correlation coefficient between theta of the CAT and mCOPD-PRO total scores using random method was 0.919 (P < 0.001), while that using MFI method was 0.760 (P < 0.001). CONCLUSIONS: The comprehensive disease-specific CAT for COPD patient-reported outcome measurement is well developed with good psychometric properties, which can provide an efficient, accurate, and user-friendly measurement for patient-reported outcome of COPD.
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Medición de Resultados Informados por el Paciente , Psicometría , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Enfermedad Pulmonar Obstructiva Crónica/psicología , Masculino , Femenino , Reproducibilidad de los Resultados , Persona de Mediana Edad , Anciano , Encuestas y Cuestionarios/normas , Calidad de VidaRESUMEN
This review meticulously evaluates the integration of behavioral change theories into pulmonary rehabilitation programs for chronic obstructive pulmonary disease (COPD) management, addressing the critical need for enhanced patient compliance and improved therapeutic outcomes. With COPD posing significant global health challenges, characterized by high morbidity and mortality rates, the manuscript underscores the potential of Self-Determination Theory, Social Cognitive Theory, the Transtheoretical Model, the Health Belief Model, and the Theory of Planned Behavior to foster meaningful health behavior changes among patients. Through a comprehensive literature analysis, it reveals how each model contributes to understanding patient behaviors in pulmonary rehabilitation contexts, advocating for their systematic application to craft more effective, patient-centered interventions. Despite the proven efficacy of these theories in various health domains, their current underutilization in pulmonary rehabilitation underscores a gap between theoretical knowledge and clinical practice. The review calls for an interdisciplinary approach that bridges this gap, highlighting the urgency of developing actionable, theory-based behavioral intervention plans. By doing so, it aims to advance COPD management strategies, ultimately improving the quality of life for individuals living with this debilitating disease.
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Conductas Relacionadas con la Salud , Enfermedad Pulmonar Obstructiva Crónica , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Enfermedad Pulmonar Obstructiva Crónica/psicología , Humanos , Calidad de Vida , Terapia Conductista/métodos , Teoría Psicológica , Cooperación del Paciente/psicología , Cooperación del Paciente/estadística & datos numéricosRESUMEN
OBJECTIVE: We explored risk factors for cognitive frailty in older patients with chronic obstructive pulmonary disease (COPD) and diabetes mellitus to develop and verify a risk prediction model for cognitive frailty. METHODS: This was a cross-sectional study. Convenience sampling was used to randomly select 378 patients hospitalized between February 2022 and December 2023. We allocated 265 patients who visited between February 2022 and February 2023 to a modeling group to analyze risk factors for cognitive frailty and create a logistic regression model for risk prediction. Another 113 patients who visited between March 2023 and December 2023 were included in a validation group for model verification. RESULTS: The cognitive frailty incidence in the 265 patients was 35.09% (93/265). Regression analysis showed that age >80 years (odds ratio [OR] = 4.576), regular exercise (OR = 0.390, polypharmacy (OR = 3.074), depression (OR = 2.395) duration of COPD combined with diabetes (OR = 1.902), Family APGAR index score (OR = 0.428), and chronic pain (OR = 2.156) were factors influencing the occurrence of cognitive frailty in older patients with COPD accompanied by diabetes. CONCLUSIONS: The constructed risk prediction model for cognitive frailty in older patients with COPD and diabetes showed good predictive value, aiding in the clinical identification of high-risk patients and facilitating timely intervention and guidance.
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Fragilidad , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/psicología , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Estudios Transversales , Factores de Riesgo , Fragilidad/epidemiología , Fragilidad/complicaciones , Fragilidad/psicología , Fragilidad/diagnóstico , Medición de Riesgo/métodos , Diabetes Mellitus/epidemiología , Anciano Frágil/psicología , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/diagnóstico , Polifarmacia , Cognición/fisiología , Modelos Logísticos , Depresión/epidemiología , Depresión/complicaciones , IncidenciaRESUMEN
BACKGROUND: The occurrence of exacerbations has major effects on the health of people with chronic obstructive pulmonary disease (COPD). Monitoring devices that measure (vital) parameters hold promise for timely identification and treatment of exacerbations. Stakeholders' perspectives on the use of monitoring devices are of importance for the successful development and implementation of a device. OBJECTIVE: This study aimed to explore the potential use and value of a wearable monitoring bracelet (MB) for patients with COPD at high risk for exacerbation. The perspectives of health care professionals as well as patients were examined, both immediately after hospitalization and over a longer period. Furthermore, potential facilitators and barriers to the use and implementation of an MB were explored. METHODS: Data for this qualitative study were collected from January to April 2023. A total of 11 participants (eg, n=6 health care professionals [HCPs], 2 patients, and 3 additional patients) participated. In total, 2 semistructured focus groups were conducted via video calls; 1 with HCPs of various professional backgrounds and 1 with patients. In addition, 3 semistructured individual interviews were held with patients. The interviews and focus groups addressed attitudes, wishes, needs, as well as factors that could either support or impede the potential MB use. Data from interviews and focus groups were coded and analyzed according to the principles of the framework method. RESULTS: HCPs and patients both predominantly emphasized the importance of an MB in terms of promptly identifying exacerbations by detecting deviations from normal (vital) parameters, and subsequently alerting users. According to HCPs, this is how an MB should support the self-management of patients. Most participants did not anticipate major differences in value and use of an MB between the short-term and the long-term periods after hospitalization. Facilitators of the potential use and implementation of an MB that participants highlighted were ease of use and some form of support for patients in using an MB and interpreting the data. HCPs as well as patients expressed concerns about potential costs as a barrier to use and implementation. Another barrier that HCPs mentioned, was the prerequisite of digital literacy for patients to be able to interpret and react to the data from an MB. CONCLUSIONS: HCPs and patients both recognize that an MB could be beneficial and valuable to patients with COPD at high risk for exacerbation, in the short as well as the long term. In particular, they perceived value in supporting self-management of patients with COPD. Stakeholders would be able to use the obtained insights in support of the effective implementation of MBs in COPD patient care, which can potentially improve health care and the overall well-being of patients with COPD.
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Grupos Focales , Personal de Salud , Enfermedad Pulmonar Obstructiva Crónica , Investigación Cualitativa , Dispositivos Electrónicos Vestibles , Humanos , Enfermedad Pulmonar Obstructiva Crónica/terapia , Enfermedad Pulmonar Obstructiva Crónica/psicología , Masculino , Femenino , Persona de Mediana Edad , Anciano , Adulto , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/métodos , Actitud del Personal de Salud , Pacientes/psicología , Pacientes/estadística & datos numéricosRESUMEN
PURPOSES: Chronic obstructive pulmonary disease (COPD) is a major cause of the rapid decline of health-related quality of life (HRQoL), associated with accelerated frailty in older populations. This study aimed to analyse the long-term dynamic changes of HRQoL and the predictive factors for the rapid decline of HRQoL in older patients with COPD. METHODS: Overall 244 patients with COPD, aged ⧠65 years from one medical centre were enrolled between March 2012 and July 2020. Further, we prospectively assessed HRQoL scores with utility values, using EuroQol Five-Dimension (EQ-5D) questionnaires. Additionally, long-term dynamic changes in HRQoL were analysed using the Kernel smoothing method and examined the factors contributing to the deterioration of HRQoL using a linear mixed effects model. RESULTS: Older patients with COPD with forced expiration volume (FEV1) < 50% of prediction entered the phase of rapid and continuous decline of HRQoL ~ 2 years after enrolment, but patients with FEV1 ≥ 50% of prediction without rapidly declined HRQoL during 7 years follow up. Therefore, FEV1 < 50% of prediction is a novel predictor for the rapid decline of HRQoL. The course of rapidly declining HRQoL occurred, initially in the usual activities and pain/discomfort domains, followed by the morbidity, self-care, and depression/anxiety domains ~ 2 and 4 years after enrolment, respectively. The mixed effects model indicated that both FEV1 < 50% of prediction and a history of severe acute exacerbation (SAE) requiring hospitalisation were contributing factors for deterioration in HRQoL . CONCLUSIONS: Both FEV1 < 50% of prediction and exacerbations requiring hospitalisation were contributing factors for the deterioration of HRQoL in long-term follow up. Additionally, FEV1 < 50% of prediction was a novel predictor for patients entering the phase of rapid decline of HRQoL.
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Enfermedad Pulmonar Obstructiva Crónica , Calidad de Vida , Humanos , Calidad de Vida/psicología , Enfermedad Pulmonar Obstructiva Crónica/psicología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Masculino , Anciano , Femenino , Estudios de Seguimiento , Encuestas y Cuestionarios , Estudios Prospectivos , Anciano de 80 o más Años , Volumen Espiratorio ForzadoRESUMEN
OBJECTIVES: Shared Decision Making (SDM) has potential to support Pulmonary Rehabilitation (PR) decision-making when patients are offered a menu of centre- and home-based options. This study sought to evaluate the feasibility and acceptability of a three-component PR SDM intervention for individuals with Chronic Obstructive Pulmonary Disease (COPD) and PR healthcare professionals. METHODS: Participants were recruited from Dec 2021-Sep 2022. Healthcare professionals attended decision coaching training and used the consultation prompt during consultations. Individuals received the Patient Decision Aid (PtDA) at PR referral. Outcomes included recruitment capability, data completeness, intervention fidelity, and acceptability. Questionnaires assessed patient activation and decisional conflict pre and post-PR. Consultations were assessed using Observer OPTION-5. Optional interviews/focus groups were conducted. RESULTS: 13% of individuals [n = 31, 32% female, mean (SD) age 71.19 (7.50), median (IQR) MRC dyspnoea 3.50 (1.75)] and 100 % of healthcare professionals (n = 9, 78% female) were recruited. 28 (90.32%) of individuals completed all questionnaires. SDM was present in all consultations [standardised scores were mean (SD) = 36.97 (21.40)]. Six healthcare professionals and five individuals were interviewed. All felt consultations using the PtDA minimised healthcare professionals' bias of centre-based PR, increased individuals' self-awareness of their health, prompted consideration of how to improve it, and increased involvement in decision-making. DISCUSSION: Results indicate the study processes and SDM intervention is feasible and acceptable and can be delivered with fidelity when integrated into the PR pathway.
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Toma de Decisiones Conjunta , Estudios de Factibilidad , Participación del Paciente , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Enfermedad Pulmonar Obstructiva Crónica/psicología , Femenino , Masculino , Anciano , Participación del Paciente/métodos , Persona de Mediana Edad , Técnicas de Apoyo para la Decisión , Encuestas y Cuestionarios , Grupos FocalesRESUMEN
BACKGROUND: Pulmonary rehabilitation plays a positive role in improving exercise tolerance and reducing readmission rates in patients with chronic obstructive pulmonary disease (COPD), while the adherence of pulmonary rehabilitation in COPD patients is still poor. The active cycle of breathing techniques based on the Hope Theory is a method to enhance patients' confidence in overcoming the disease and improve the intrinsic motivation of exercise through symptom improvement such as cough and sputum evacuation ability. OBJECTIVES: To investigate the effect of Hope Theory education combined with the active cycle of breathing techniques on pulmonary rehabilitation of COPD patients, including exercise adherence, cough and sputum evacuation ability, hope index and exercise self-efficacy. METHODS: The study assigned 70 COPD patients hospitalized into intervention and control groups to receive the active cycle of breathing techniques based on Hope Theory or routine treatment in order of admission. Data for cough and sputum evacuation ability, hope, exercise confidence were collected at baseline and after the program. Exercise adherence was assessed at the end of 1, 4 and 8 week following discharge. RESULTS: The actual number of sample consisted of 65 patients divided into intervention (n = 33) and control (n = 32) groups due to severe complications, explicit refusal, disinterest and loss to follow-up. After two weeks of intervention, exercise adherence of the intervention group were better than those of the control group at the end of 4 and 8 week of discharge (P < 0.05). And there was an improvement in cough and sputum evacuation ability, hope and exercise self-efficacy outcomes in the intervention group, with a statistically significant difference between the two groups (P < 0.05). CONCLUSION: The active cycle of breathing techniques based on Hope Theory education can improve cough and sputum evacuation ability, hope index, exercise self-efficacy, and exercise adherence of COPD patients.
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Enfermedad Pulmonar Obstructiva Crónica , Humanos , Enfermedad Pulmonar Obstructiva Crónica/psicología , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Masculino , Femenino , Anciano , Persona de Mediana Edad , Esperanza , Ejercicios Respiratorios/métodos , AutoeficaciaRESUMEN
BACKGROUND: Loneliness poses significant public health concerns on a global scale. Being alone and lacking social connections have been proven to impact prognosis and response to treatment in different diseases, including COPD. Yet, the prevalence and burden of loneliness on COPD outcomes remain unclear. METHODS: Various relevant databases were systematically searched in March 2024. The quality of the studies included was assessed using a modified Newcastle-Ottawa Scale. The random effect model was used to compute the pooled prevalence and associated 95 % confidence intervals (95%CI) of loneliness and living alone in COPD patients. RESULTS: After reviewing 256 studies, 11 studies, including 4644 COPD patients, met the inclusion criteria and were included in the systematic review. Of the included studies, 5/11 (45.5%) reported the prevalence of loneliness or lone living among COPD patients and were included in the meta-analysis. The prevalence of loneliness and lone living among COPD patients was 32% (95% CI = 16%-48%) and 29% (95% CI = 16%-41%), respectively. The Three-item UCLA loneliness scale was the most often used loneliness assessment tool (5/11, 45.5%). Loneliness and lone living were associated with poor outcomes, including emergency department visits, readmissions, depression, and reduced pulmonary rehabilitation response. CONCLUSION: Despite one-third of COPD patients experiencing loneliness, researchers have not consistently documented its impact on COPD outcomes. More studies are needed to assess the impact of loneliness on COPD and how to mitigate the negative effects on patients' outcomes.
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Soledad , Enfermedad Pulmonar Obstructiva Crónica , Soledad/psicología , Enfermedad Pulmonar Obstructiva Crónica/psicología , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Humanos , Prevalencia , Costo de Enfermedad , Femenino , Masculino , Calidad de Vida , AncianoRESUMEN
To investigate the effect of positive psychological capital on the health-promoting lifestyle of patients with chronic obstructive pulmonary disease (COPD) and the intermediary effects of life satisfaction and learned helplessness. A total of 482 patients who completed the pulmonary rehabilitation course at the Nantong Sixth People's Hospital of Jiangsu Province were surveyed using a self-designed questionnaire battery, encompassing the positive psychological capital, health-promoting lifestyle, life satisfaction, and learned helplessness scales. A total of 469 of the 482 questionnaires distributed were effectively returned, leading to an effective response rate of 97.3%. The mean scores on the positive psychological capital, life satisfaction, learned helplessness, and health-promoting lifestyle scales were 105.56â ±â 10.44, 19.89â ±â 6.33, 50.14â ±â 5.47, and 104.22â ±â 10.44, respectively. The structural equation model demonstrated good fit indexes. The path analysis revealed that positive psychological capital had a direct effect of 0.431 on health-promoting lifestyle, while life satisfaction and learned helplessness had a mediating effect on this relationship (both Pâ <â .05). Patients with COPD have low levels of positive psychological capital and health-promoting lifestyle. Thus, addressing psychological problems and providing continuous rehabilitation nursing to strengthen the psychological construct are essential in this patient group. Moreover, the positive psychological capital of patients with COPD can directly predict their health-promoting lifestyle and exert an influence via the chain mediating effect of life satisfaction and learned helplessness. Therefore, clinical medical staff should assess the positive psychological capital of patients with COPD and adjust the daily rehabilitation activities according to the patients' mental state. Furthermore, enhancing the patients' life satisfaction by employing diverse strategies to reduce learned helplessness can notably improve the health-promoting lifestyle of those with COPD.
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Desamparo Adquirido , Satisfacción Personal , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Enfermedad Pulmonar Obstructiva Crónica/psicología , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Femenino , Masculino , Persona de Mediana Edad , Anciano , Estilo de Vida Saludable , Encuestas y Cuestionarios , Estilo de VidaRESUMEN
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is commonly associated with anxiety/depression which can affect self-management and quality of life. The TANDEM trial evaluated a cognitive behavioural approach intervention targeting COPD-related symptoms of anxiety and/or depression, comprising up to eight one-to-one sessions delivered by respiratory healthcare professionals prior to pulmonary rehabilitation (PR). The intervention showed no improvement in anxiety/depression or uptake/completion of PR. We present patient perspectives of the intervention to help understand these results. METHOD: Semi-structured individual interviews, using a semi-structured topic guide informed by Sekhon's Theoretical Framework of Acceptability, were conducted with 19 patients between September 2019 and April 2020. The interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS: The following could have limited the impact of the intervention: (1) The lives of patients were complex and commonly affected by competing comorbidities or other external stressors which they managed through previously adopted long-standing coping strategies. (2) Some patients were reluctant to talk about their mood despite the Facilitators' training and person centred-skills which aimed to enable patients to talk freely about mood. (3) The intervention handouts and 'home-practice' were perceived as helpful for some, but not suitable for all. (4) Many patients perceived improvements in their physical and mental health, but this was not sustained due to a mix of personal and external factors, and some did not perceive any benefits. (5) PR non-attendance/non-completion was a result of personal and PR service-related reasons. (6) Discussing COPD and mental health with the Facilitator was a novel experience. Many patients felt that TANDEM could be of benefit if it was offered earlier on/at different time points in the COPD illness journey. CONCLUSION: We found the delivery of TANDEM prior to PR was not helpful for patients with advanced COPD often experiencing other comorbidities, and/or difficult personal/external events. These patients already utilised long-standing coping strategies to manage their COPD. Holistic interventions, that address the impact of COPD in relation to wider aspects of a patients' life, may be more beneficial. TRIAL REGISTRATION: ISRCTN Registry 59,537,391. Registration date 20 March 2017.
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Depresión , Enfermedad Pulmonar Obstructiva Crónica , Investigación Cualitativa , Humanos , Enfermedad Pulmonar Obstructiva Crónica/psicología , Enfermedad Pulmonar Obstructiva Crónica/terapia , Masculino , Femenino , Anciano , Persona de Mediana Edad , Depresión/terapia , Ansiedad/terapia , Calidad de Vida , Terapia Cognitivo-Conductual/métodos , Entrevistas como Asunto , Adaptación PsicológicaRESUMEN
Introduction: Chronic obstructive lung diseases, such as asthma and COPD, appear to have a more extensive impact on overall functioning than previously believed. The latest data from clinical trials suggests a potential link between cognitive deterioration and chronic obstructive inflammatory lung disease. This raises the question of whether these diseases affect cognitive functions and whether any relevant biomarker may be identified. Methods: This prospective observational study included 78 patients divided equally into asthma, COPD, and control groups (n=26, 27 and 25 respectively). The participants underwent identical examinations at the beginning of the study and after at least 12 months. The test battery comprised 16 questionnaires (11 self-rated, 5 observer-rated, assessing cognition and mental state), spirometry, and blood samples taken for PKA and CREB mRNA evaluation. Results: A 2.3-fold increase in CREB mRNA was observed between examinations (p=0.014) for all participants; no distinctions were observed between the asthma, COPD, and control groups. Pooled, adjusted data revealed a borderline interaction between diagnosis and CREB expression in predicting MMSE (p=0.055) in COPD, CREB expression is also associated with MMSE (ß=0.273, p=0.034) like with the other conducted tests (ß=0.327, p=0.024) from COPD patients. No correlations were generally found for PKA, although one significant negative correlation was found between the first and second time points in the COPD group (ß=-0.4157, p=0.049),. Discussion: Chronic obstructive lung diseases, such as asthma and COPD, may have some linkage to impairment of cognitive functions. However, the noted rise in CREB mRNA expression might suggest a potential avenue for assessing possible changes in cognition, especially in COPD; such findings may reveal additional transcription factors linked to cognitive decline.
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Disfunción Cognitiva , Proteína de Unión a Elemento de Respuesta al AMP Cíclico , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Masculino , Femenino , Disfunción Cognitiva/etiología , Disfunción Cognitiva/diagnóstico , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/psicología , Proteína de Unión a Elemento de Respuesta al AMP Cíclico/genética , Anciano , Estudios Prospectivos , Asma/psicología , Asma/diagnóstico , Biomarcadores/sangre , Adulto , Proteínas Quinasas Dependientes de AMP Cíclico/metabolismo , ARN Mensajero/genéticaRESUMEN
BACKGROUND: Anxiety and depression are prevalent comorbidities in patients with chronic obstructive pulmonary disease (COPD). However, existing research has yielded conflicting findings regarding the effects of social frailty on anxiety and depression. The primary aim of this study is to validate the relationship between social frailty and social support with anxiety and depression in patients with acute exacerbations of COPD (AECOPD) and to investigate whether social support could explain the variations in prior study outcomes for patients with AECOPD. METHODS: Of the 315 patients hospitalized with AECOPD at the respiratory intensive care unit of a large tertiary care institution in Sichuan Province of China, between August 2022 and June 2023 who were surveyed, 306 were included in the analysis after excluding missing data. We conducted a logistic regression analysis to examine the associations of social frailty and social support with anxiety and depression and performed mediation analyses to examine whether social support mediates the relationship of social frailty with anxiety and depression. RESULTS: The logistic regression analysis revealed that social frailty did not associate anxiety or depression in patients with AECOPD. The mediation analysis supported this idea and indicated that while social frailty does not directly influence anxiety or depression, it can through social support. CONCLUSIONS: The findings suggest that while social frailty may not directly impact anxiety or depression in patients with AECOPD, social support plays a crucial mediating role. Enhancing social support can indirectly alleviate anxiety and depression among these patients. Enhancing social support networks should thus be prioritized by healthcare providers and family members to improve mental health outcomes in this patient population.
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Ansiedad , Depresión , Enfermedad Pulmonar Obstructiva Crónica , Apoyo Social , Humanos , Masculino , Femenino , Anciano , Depresión/epidemiología , Depresión/psicología , Ansiedad/epidemiología , Ansiedad/psicología , Enfermedad Pulmonar Obstructiva Crónica/psicología , Persona de Mediana Edad , China/epidemiología , Fragilidad/psicología , Modelos Logísticos , Anciano de 80 o más AñosRESUMEN
Individuals with chronic obstructive pulmonary disease (COPD) experience high symptom burden, severe illness, and frequent deterioration in quality of life. Women with COPD represent a unique population with potential unmet care needs yet remain underrepresented in palliative care (PC) literature. The purpose of this study was to investigate specific needs of women with COPD, learn how COPD symptoms impact women, and explore factors related to PC knowledge, access, and barriers. A total of 30 individuals were enrolled in this prospective, single-arm multimethod study, using an adapted Maslow's hierarchy of needs framework. Fifteen participated in semistructured interviews. Women with advanced COPD identified care needs and barriers including access to medications/oxygen and resources (pulmonary rehabilitation/support groups), information about disease/treatment, and effect of weather conditions on symptoms. Some participants were not under the direct care of a pulmonologist but recognized the importance of their services. None of the participants had been referred to or received PC. This study provides evidence that women have unmet care needs, high symptom burden, and disease uncertainty. Women with COPD should have the opportunity to have the supportive care that PC offers. Palliative care and hospice nurses have opportunities to address unmet care needs, increased symptom burden, and disease uncertainty.
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Cuidados Paliativos , Enfermedad Pulmonar Obstructiva Crónica , Investigación Cualitativa , Humanos , Enfermedad Pulmonar Obstructiva Crónica/terapia , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/psicología , Femenino , Cuidados Paliativos/métodos , Anciano , Estudios Prospectivos , Persona de Mediana Edad , Evaluación de Necesidades/tendencias , Evaluación de Necesidades/estadística & datos numéricos , Anciano de 80 o más Años , Calidad de Vida/psicologíaRESUMEN
Chronic obstructive pulmonary disease (COPD) is a significant respiratory disease and is globally ranked as the third leading cause of death. In Canada, the direct healthcare costs associated with COPD are estimated to be $1.5 billion annually. This study utilized quantitative analyses to examine the impact of specific dimensions of social support, namely, guidance, reliable alliance, reassurance of worth, attachment, and social integration within a clinically identified population of individuals with COPD who exhibit symptoms of depression and anxiety. The study was based on the Social Provisions Theory and stress-buffering hypothesis, utilizing large-scale population data from Statistics Canada's 2012 Canadian Community Health Survey (CCHS) Mental Health component. On a national scale, individuals were more likely to report a decreased sense of belonging to a group of friends (social integration) and struggle to depend on others in stressful times (reliable alliance) while experiencing symptoms of anxiety and depression. These findings underscore the potential benefits of integrating peer support, socialization initiatives, and caregiver training into clinical programs designed for individuals with COPD.
Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica , Apoyo Social , Humanos , Enfermedad Pulmonar Obstructiva Crónica/psicología , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Canadá/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Salud Mental/estadística & datos numéricos , Depresión/epidemiología , Depresión/psicología , Anciano , Ansiedad/epidemiología , Ansiedad/psicología , Adulto , Bienestar PsicológicoRESUMEN
The purpose of this study was to develop and test the reliability and validity of a brief and comprehensive instrument to assess self-management, decision-making, and coping by chronic obstructive pulmonary disease (COPD) patients. A web-based questionnaire was administered to 300 COPD patients and a retest was administered to 100 COPD patients. Cronbach's alpha was used to assess internal consistency, and an intraclass correlation coefficient was calculated to test the reliability of the retest. The convergent and discriminant validities were also examined. Valid responses were obtained from 279 participants in the first survey and 70 participants in the retest. From our analysis, a COPD self-care assessment scale (CSCS) was developed, consisting of seven subscales and 14 items. Cronbach's alpha for the total CSCS score, intraclass correlation coefficient, and scale success rate were 0.80, 0.79, and 100%, respectively. A multivariate analysis showed that CSCS was associated with current smoking (standardized partial regression coefficient [std ß] = -0.30; p < 0.001), long-term oxygen therapy (std ß = 0.23; p < 0.001), and social support (std ß = 0.24; p < 0.001), but not psychological symptoms or quality of life. The CSCS is also useful in assessing self-management, decision-making, and coping in Japanese COPD patients, and the scale has high reliability and validity.
Asunto(s)
Adaptación Psicológica , Toma de Decisiones , Enfermedad Pulmonar Obstructiva Crónica , Autocuidado , Automanejo , Humanos , Enfermedad Pulmonar Obstructiva Crónica/terapia , Enfermedad Pulmonar Obstructiva Crónica/psicología , Masculino , Femenino , Anciano , Encuestas y Cuestionarios , Persona de Mediana Edad , Reproducibilidad de los Resultados , Apoyo Social , Calidad de VidaRESUMEN
Patients with chronic and serious illnesses experience significant quality of life concerns. More research is needed to understand the impact of financial burden on patients with COPD, heart failure, and kidney failure. Patients with COPD, heart failure, or kidney failure completed a cross-sectional online survey using validated measures of financial burden (general financial strain as well as financial toxicity attributable to treatment), physical quality of life (symptom burden and perceived health), and emotional quality of life (anxiety, depression, and suicidal ideation). ANCOVA was used to examine whether financial strain and financial toxicity were associated with physical and emotional quality of life, while accounting for key covariates. Among 225 participants with COPD (n = 137), heart failure (n = 48), or kidney failure (n = 40), 62.2% reported general financial strain, with 34.7% experiencing financial toxicity attributable to treatments. Additionally, 68.9% rated their health as fair or poor, experiencing significant symptom burden including fatigue, dyspnea, and chest pain. Participants also reported clinically relevant levels of anxiety (55.1%), depression (52.0%), and suicidal ideation (21.8%). In the total sample, financial strain was associated with worse physical and emotional quality of life on all measures (all Ps < .001). Financial toxicity attributable to treatment was not associated with quality of life in the total sample or subsamples. Patients with COPD, heart failure, and kidney failure face significant financial, physical, and emotional burdens. Financial strain appears to undermine physical and emotional quality of life. Our study highlights the demand for interventions aimed at mitigating financial strain and toxicity experienced by individuals with chronic illnesses.
Asunto(s)
Costo de Enfermedad , Insuficiencia Cardíaca , Enfermedad Pulmonar Obstructiva Crónica , Calidad de Vida , Insuficiencia Renal , Humanos , Insuficiencia Cardíaca/psicología , Insuficiencia Cardíaca/economía , Masculino , Femenino , Enfermedad Pulmonar Obstructiva Crónica/economía , Enfermedad Pulmonar Obstructiva Crónica/psicología , Persona de Mediana Edad , Anciano , Estudios Transversales , Insuficiencia Renal/psicología , Insuficiencia Renal/economía , Depresión/psicología , Depresión/economía , Ansiedad/psicología , Emociones , Encuestas y Cuestionarios , Ideación Suicida , Estrés Financiero/psicologíaRESUMEN
Chronic Obstructive Pulmonary Disease is a progressive lung disease associated with anxiety, depression, and reduced health-related quality of life. Pulmonary rehabilitation (PR) is a cost-effective and transformative treatment, but 31% of referred patients do not take up their PR appointment. The study aimed to develop user requirements for an intervention to increase PR uptake. A systems approach, the Engineering Better Care framework, was used to develop a system map of the PR pathway, translate evidence-based user needs into user requirements, and validate the user requirements in a stakeholder workshop. Eight user requirements addressed patient and health care practitioner needs to understand what PR entails, understand the benefits of PR and have positive conversations about PR to address patient concerns. The solution-independent user requirements can be applied to the development of any intervention sharing similar goals. The study demonstrates potential in taking a systems approach to more challenges within respiratory medicine.