Healthcare professionals’ perceptions of pulmonary rehabilitation as a management strategy for patients with chronic obstructive pulmonary disease: a critical interpretive synthesis

Abstract

Carol (2020) Healthcare professionals' perceptions of pulmonary rehabilitation as a management strategy for patients with chronic obstructive pulmonary disease: a critical interpretive synthesis. Disability and Rehabilitation.

Contextual factors for the successful implementation of self-management interventions for chronic diseases: A qualitative review of reviews

“…39,40,44 For obesity and COPD practical matters such as location, time of appointment, long waiting lists, expense or work or family commitments were reported as an access barrier. 43,45,46 Another review described that case management was perceived by HF patients to facilitate access to overall care. 42 Feasibility.…”

“…Multiple reviews described examples in which HCPs' lack of knowledge and skills influenced patients' self-management behaviours. 24,26,28,29,33,36,37,41,45,46,48,50,[54][55][56][57] For example, a review reported about HCPs' unfamiliarity with existing guidelines about the diagnosis and management of HF, little knowledge about medication and some HCPs that still treated HF as an acute illness, negatively affecting patients' self-management. 37 A lack of providers' communication skills is also considered an important barrier to successful self-management support.…”

“…In general, inaccurate health beliefs and lack of knowledge amongst patients have been reported as important barriers to adequate self-management and the ability to learn new behaviour. [24][25][26][33][34][35][41][42][43]46,49,50,53,[55][56][57][62][63][64][65][66][67][68] For example, HF patients with a low level of knowledge perceived significantly more barriers to medication adherence, following a diet and symptom recognition compared to patients with a higher level of knowledge. 65 The presence of negative fatalistic beliefs can lead to passive behaviour in patients who believe that they are not able to influence outcomes of their condition.…”

“…The communication between patient and provider and the quality of their relationship were described in multiple reviews as impacting patients' selfmanagement behaviour. 27,28,32,34,36,43,47,48,50,54,[58][59][60] Both can be influenced, amongst others, by a provider's communication skills and expertise, 24,27,[34][35][36][37]43,46,47,66 patient characteristics, 24,25,27,32,[34][35][36]43,47 conflicting views of care, 24,26,43,47,74 and (a lack of) continuity of care. 25,28,34,37,43,51,56,59 Examples of communication skills that have a positive effect on patient's ability to self-management are showing empathy, active listening, providing emotional support and non-judgmental communication.…”

“…Some reviews expressed concerns about the limited availability of patient education materials. 46,57 Patients specifically valued information on the nature of the disease, its underlying processes in relation to the symptoms and its long-term consequences, as well as how medications work, the influence of lifestyle factors and management strategies. 24 However, some patients found it difficult to apply the information they received to their daily lives and needs.…”