Factors influencing exacerbation-related self-management in patients with COPD: a qualitative study

Abstract

BackgroundIn patients with COPD, self-management skills are important to reduce the impact of exacerbations. However, both detection and adequate response to exacerbations appear to be difficult for some patients. Little is known about the underlying process of exacerbation-related self-management. Therefore, the objective of this study was to identify and explain the underlying process of exacerbation-related self-management behavior.MethodsA qualitative study using semi-structured in-depth interviews was performed according to the grounded theory approach, following a cyclic process in which data collection and data analysis alternated. Fifteen patients (male n=8; age range 59–88 years) with mild to very severe COPD were recruited from primary and secondary care settings in the Netherlands, in 2015.ResultsSeveral patterns in exacerbation-related self-management behavior were identified, and a conceptual model describing factors influencing exacerbation-related self-management was developed. Acceptance, knowledge, experiences with exacerbations, perceived severity of symptoms and social support were important factors influencing exacerbation-related self-management. Specific factors influencing recognition of exacerbations were heterogeneity of exacerbations and habituation to symptoms. Feelings of fear, perceived influence on exacerbation course, patient beliefs, ambivalence toward treatment, trust in health care providers and self-empowerment were identified as specific factors influencing self-management actions.ConclusionThis study provided insight into factors influencing exacerbation-related self-management behavior in COPD patients. The conceptual model can be used as a framework for health care professionals providing self-management support. In the development of future self-management interventions, factors influencing the process of exacerbation-related self-management should be taken into account.

Living with chronic obstructive pulmonary disease: The stories of frequent attenders to the Emergency Department

“…This study has explored the experience of living with COPD from the perspective of individuals and their carers who present frequently to EDs. Several themes which emerged from this study share commonalities with the broader COPD literature (Cruz, Marques, & Figueiredo, ; Korpershoek, Vervoort, Nijssen, Trappenburg, & Schuurmans, ; Laue, Melbye, & Risør, ; Tang & Lee, ; Williams, Hardinge, Ryan, & Farmer, ). It is of interest that despite these commonalities in their experiences, participants in this study were frequent attenders at the ED.…”

“…Unlike the broader literature which highlights the impact of late identification of signs and symptoms of exacerbation (Korpershoek et al, 2016), many participants identified early symptoms which indicated deterioration, with many self-implementing medication regimes. In part, at least, this self-care may have been due to less than ideal access to appropriate health professionals at these critical points.…”

“…Our study highlighted widespread use of action plans for patients to implement for the management of COPD symptoms, especially at times when these were exacerbated. Adherence to written action plans is associated with improved quality of life, decreased impact of deterioration on health status and reductions in exacerbation recovery time (Bischoff et al, 2011;Jalota & Jain, 2016;Korpershoek et al, 2016). There is a significant body of literature around strategies to enhance the use of action plans within COPD (Howcroft, Walters, Wood-Baker, & Walters, 2016;Jalota & Jain, 2016).…”

The experience of being a participant in one’s own care at discharge and at home, following a severe acute exacerbation in chronic obstructive pulmonary disease: a longitudinal study

“…A Dutch study indicated that patients with COPD to a minor-to-severe degree were challenged in recognition of exacerbations and, consequently, in taking adequate self-management action, such as seeking help. Having trust in healthcare professionals was one of the factors that influenced how patients approached these challenges (Korpershoek, Vervoort, Nijssen, Trappenburg, & Schuurmans, 2016). Other research on patients’ needs following a hospital discharge after an AECOPD points to a need for personalized self-management advice about when and how to call for help (Gruffydd-Jones, Langley-Johnson, Dyer, Badlan, & Ward, 2007).…”

HemoHIM, a herbal preparation, alleviates airway inflammation caused by cigarette smoke and lipopolysaccharide

“…As COPD increases, the cost of treatment is also increases, and the quality of life declines [2]. COPD is characterized by airway inflammation, mucus secretion and emphysema that resulted reduction of pulmonary function [34].…”