Patient Reported Determinants of Health: A Qualitative Analysis of Veterans with Chronic Obstructive Pulmonary Disease

Abstract

Although COPD is a common disorder of veterans who receive care from the Veterans Healthcare Administration (VHA), the perceptions of veterans with COPD about their disease, its effects on their lives, and their interactions with the VHA have not been determined. Utilizing qualitative methodology, we conducted focus groups of veterans with COPD at the Cincinnati VA Medical Center. Participants were selected by systematic sampling from the top quintile of veterans stratified by the cost of healthcare utilization related to a primary diagnosis of COPD and grouped by age and use of supplemental oxygen. All 42 participants were male and had a mean age of 65 years. Analysis of the focus group transcripts demonstrated five major themes: 1) Physical and Functional Limitations: work and employment constraints, recreation restrictions, limits on activities of daily living, reduced sexuality, concerns about housing and finances, and physical symptoms; 2) Restricted Social Interactions/Altered Social Networks: altered relationships with friends and family and reliance upon family and care givers; 3) Emotional Effects: reduced self-worth, vulnerability, depression, perseverance and adaptation, hopelessness, fear, pride, and lack of control; 4) Limitations in the Understanding of COPD: unawareness of diagnosis, triggers and reaction to disease manifestations, COPD management; and 5) Complex Healthcare Interactions. COPD pervasively and extensively affects all aspects of veterans' lives and causes significant consequences for their care and management.

A Qualitative Exploration of Exercise Among Pulmonary Rehabilitation Participants: Insight From Multiple Sources of Social Influence

“…The importance of the supportive nature of PR programs is consistent with another qualitative study that explored long-term maintenance of exercise among individuals diagnosed with COPD 15 and research regarding social support and exercise maintenance in COPD. 31 The results from this study make a unique contribution to the literature by further demonstrating the importance of support beyond peers to include support from PR staff.…”

“…Although increasing, research informed by additional approaches (eg, qualitative) remains an important growth area within the COPD field and may serve to complement quantitative findings. 13,15,16 Without obtaining in-depth information of this nature, important aspects of exercise and preferences of those diagnosed with COPD may be missed. 17 Another gap within the literature pertains to studying exercise beyond an individual level and including social influences (eg, spouses, health-care staff) to contextualize individual behavior and experiences.…”

Therapeutic paralysis in Veterans with COPD

“…This study corroborates and extends the findings of our qualitative study at the Cincinnati VAMC using focus groups of Veterans with the highest COPD-related healthcare cost (quintile 1 of the current study). 12 Veterans with the greatest COPD-related healthcare utilization are more likely to know their diagnosis, receive care at the Cincinnati VAMC, have limitations in a number of activities, and experience more negative emotions than individuals who utilize less COPD-related healthcare. These Veterans have worse lung function but similar frequencies of co-morbidities.…”

“…29 As individuals with COPD become more debilitated, they encounter increased physical limitations leading to a more sedentary lifestyle, restricted social interactions, and diminished enjoyment of activities that further reduces physical conditioning and function exacerbating feelings of low self worth and depression. 12 While the effect of COPD on social networks has not been studied extensively, patients with COPD who are socially isolated and homebound experience an increased risk of hospitalization. 30, 31 …”

“…12 The major patient-identified areas were diagnosis and communication of the diagnosis of COPD; the physical effects of COPD upon life activities; the emotional effects of COPD and its manifestations; VHA care and interactions with the VHA healthcare system; inhaler use and reasons for non-adherence; role of various caregivers in patient education about COPD; use of non-pharmacologic therapies; and patients’ reactions to breathlessness.…”