This study illuminates the challenge of how to combine health advice on smoking cessation with nonblaming psycho-social support throughout the course of COPD. An awareness of the potential for stigma, the nature of nicotine dependence and broadened causal explanations for the disease may improve the ability of caregivers to address patient strain and its negative association with coping and well-being. Dilemmas in health communication concerning COPD patients' experience of stigma and negative emotional response should be further explored.

People who live with chronic obstructive pulmonary disease (COPD) experience major changes in health. Coping with the illness and caring for themselves places extensive demands on them. Thus, pulmonary rehabilitation (PR) is recommended as a means to facilitate healthy transitions in everyday life with COPD. This study explores the experience of patients with COPD in terms of their transitions in health during and after PR. The research was inspired by interpretive phenomenology. Thirty-three individual qualitative interviews were conducted with eighteen patients recruited from Norwegian PR units. A thematic analysis of the interviews was performed. The interviewees described participation in PR as a time of increasing awareness of opportunities for health and well-being with strengthened hope. The year following PR was dominated by their ongoing challenge to acknowledge limitations and explore opportunities in everyday life. Continuation of healthy transitions was facilitated by peer and professional support. The study highlights the personal resources that patients with COPD have access to in order to promote their own health. The study also highlights their vulnerability during illness and rehabilitation. The findings critique time-limited PR and support the current trends towards patient-centred rehabilitation efforts that incorporate user involvement and self-management education.

AimTo unpack and interpret descriptions of experiences of social relationships during pulmonary rehabilitation (PR) for people living with chronic obstructive pulmonary disease (COPD).MethodInspired by interpretive phenomenology, individual qualitative interviews were conducted twice with 18 persons from COPD rehabilitation units in two general hospitals. Qualitative content analysis was performed.ResultsAnalysis of the interviews revealed the overarching theme of belonging. The participants emphasised social integration in rehabilitation groups as well as support from peers and health-care personnel as important dimensions of social relationships with regard to PR. Active participation in and engagement with the groups provided opportunities for patients to share their knowledge, encouraged mutual trust, and support and increased self-confidence, and motivation for self-care and further social participation. Integration in the groups and perceived support during PR made coping and adaptation easier and had a positive effect on quality of life.ConclusionsPatients' perspectives on PR were strongly influenced by certain facets of social relationships, such as social integration and social support. Patients', peers' and health-care professionals' strategies to promote social support and social integration should be further explored in the future, both in different contexts and for longer periods of time.

This article discusses in-depth interviews of 12 persons, who had been diagnosed for cancer from 6 months to 3 years earlier, concerning what it is like to live with the diagnosis of cancer. The persons interviewed were aged 43-70 years, and 11 of the 12 had received successful radical treatment; one patient was treated for symptoms, but with an uncertain future development. This investigation shows that the period of waiting from the first suspicion of cancer until diagnosis confirmation of the disease was a period of great stress, and that the following period until the commencement of treatment was also a very difficult one. The investigation also shows that there was no follow-up of individual patients concerning their need to talk about their difficult new life-situation brought about by the disease. Receiving the diagnosis of cancer was remembered as being a very dramatic experience for the informants. The informants were satisfied with the medical treatment they received, but they also feel that there should have been some kind of programme available to care for their psycho-social needs. In the rehabilitation phase, they feel that they were left to their own resources; during this period, they felt physically and mentally drained, and they did not have the knowledge to tackle their new and difficult life-situation. The threat of new cancer cells being discovered is always with patients. Attending the check-ups is also described as a period of stress.

PurposeTo explore how persons living with COPD experience transitions related to health, self-management, and follow-up from the healthcare services.Patients and methodsThis study is part of a participatory research project. Six males and five females living with COPD, with a COPD assessment test score of 21–29, participated; all the participants were living at home. Data were collected in qualitative research interviews and analyzed using qualitative content analysis highlighting the participants’ experiences.ResultsThe findings showed two main themes: “The struggle to keep going” and “The need for continuity and competent facilitation”. The participants reported complex health transitions, with changes in roles and function, demanding exacerbations and critical events, and challenges with learning needed self-management. They expressed a great need for and had great benefit from, education, rehabilitation, and follow-up in their management of everyday life. Not all received offers in line with current guidelines.ConclusionIn-depth knowledge of patients’ experienced COPD transitions offers clinicians guidance for the timing and quality of follow-up services. Life with COPD entails challenging transitions in health and self-management. Good rehabilitation and follow-up from the healthcare services are needed throughout the disease trajectory. Participation in self-management education and rehabilitation that include psychosocial aspects may facilitate health-enhancing transitions and improve self-management skills. Experienced lack of competence and flexibility among healthcare providers hinders trust and collaboration. Access to stable and competent follow-up in the primary health services may facilitate cohesive services and collaborative self-management.

Care providers need to be skilled in assessing each individual's resources and interpretations of their condition, to be able to communicate in a respectful, patient-centred manner and to assist adolescents to explore their ambivalence and set their own realistic goals. More research is needed.

Introduction An increasing share of surgical activity is organised as day surgery, thus giving more responsibility for care to patients and their next of kin. Purpose To obtain increased understanding of orthopaedic day surgery patients’ experiences with self‐management. Methods A descriptive interview study. Eleven men and five women aged 18–78 years, who had undergone arthroscopic knee surgery in rural Norway participated in qualitative individual interviews during autumn 2018. Systematic text condensation was used as analysis strategy. Results The main theme a planned but vulnerable pathway towards self‐management and five subthemes were highlighted. The interviewees were satisfied with most aspects of the day surgery. However, challenges in adapting oral and written information to self‐management postdischarge, a need for further self‐management support at home, and strenuous travel increased the strain. Conclusion The written and oral information and support that was planned and provided by the hospital did not meet the patients’ needs for self‐management support postdischarge. The day surgery care pathway seemed to lack effective educational interventions for strengthening the patients’ self‐efficacy and control and to have potential for improvements.

PurposeTo describe a cohort of chronic obstructive pulmonary disease (COPD) patients and perform a within-group comparison regarding self-management activation, social provision, and health status.Patients and methodsA cross-sectional survey including 116 persons.ResultsThe sample comprised 65 men and 38 women, mean age 69 years. Fourteen percent reported very high impact of COPD on their health; 19% had received pulmonary rehabilitation offers, 39% had been offered self-management education, and 64% had acute hospital admissions due to COPD complications in the past year. Persons with COPD Assessment Test (CAT) scores ≥30 reported significantly poorer self-management activation and significantly lower social provision than those reporting CAT scores <30. Number of COPD years had no significant influence on COPD health care consultations or self-management activation.ConclusionPersons with COPD reported decreasing social provision with increasing COPD years and poorer health status. Although COPD is a progressive disease, health status and self-management activation did not vary with number of COPD years. Those living with a very high COPD impact on health reported significantly lower self-management activation but fewer acute hospital admissions.Practice implicationsCOPD patients’ need for pulmonary rehabilitation, self-management support, and social support should be assessed and appropriate services offered throughout the disease trajectory.