The Importance of Self-Management in the Context of Personalized Care in COPD

Abstract

Despite current guidelines and decades of evidence on the benefits of a self-management approach, self-management of COPD remains relatively under-utilized in clinical care compared with other chronic diseases. However, self-management interventions can play a valuable role in supporting people with COPD to respond to changing symptoms, and thereby make appropriate decisions regarding the management of their own chronic condition. In this review, we discuss the history and evolution of the concept of self-management, assess current multidisciplinary support programs and clinical interactions designed to optimize self-management, and reflect on how effective these are in terms of clinical and humanistic outcomes. We also evaluate the mechanisms for encouraging change from protocol-based care towards a more personalized care approach, and discuss the role of digital self-management interventions and the importance of addressing health inequalities in COPD treatment, which have been accelerated by the COVID-19 pandemic. Reflecting on the importance of self-management in the context of symptom monitoring and provision of educational support, including information from patient organizations and charities, we discuss the ideal components of a self-management plan for COPD and provide six key recommendations for its implementation: 1) better education for healthcare professionals on disease management and consultation skills; 2) new targets and priorities for patient-focused outcomes; 3) skills gap audits to identify barriers to self-management; 4) best practice sharing within primary care networks and ongoing professional development; 5) enhanced initial consultations to establish optimal self-management from the outset; and 6) negotiation and sharing of self-management plans at the point of diagnosis.

Patient and Health Care Provider Perspectives on Potential Preventability of Hospital Admission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Qualitative Study

“…Despite current guidelines and decades of evidence on the benefits of a self-management approach, self-management of COPD remains relatively underutilized. 20 Action plans are a key self-management intervention, 9 and it is remarkable that only one patient was able to define an action plan, and none of the patients reported having an action plan in place, despite 6 HCPs reporting that they had discussed an action plan with the patient in the past. This finding is in line with other study findings that adherence to action plans is generally low.…”

Non-pharmacological interventions for self-management of fatigue in adults: An umbrella review of potential interventions to support patients recovering from critical illness

“…In stroke rehabilitation, the self-management described by Howell et al [22], Cravo et al [11], and Lorig and Holman [13] has been termed 'supported self-management' to differentiate it from more basic approaches such as symptom tracking and lifestyle changes alone [52]. This is a useful delineation, as the difference in time and resource requirements and activities involved is substantial.…”

“…Most (14/17) relevant interventions with positive effects included involvement from a health professional, researcher, or trained facilitator, and Agbejule et al [23] found that interventions facilitated by health professionals with at least one face-to-face session were most likely to have positive effects. Shared decision-making activities and partnership between patient and facilitator are considered central to self-management [11,13]. Dineen-Griffin et al [59] also identified that a structured provider-patient exchange in self-management should involve a one-to-one session, provision of self-management support materials, and ongoing follow-up.…”

“…The importance of this has been further highlighted by the challenges of the COVID-19 pandemic. Self-management is increasingly being recognised as an invaluable rehabilitation tool for patients managing chronic illnesses or conditions with extended recovery periods and has been shown to improve health outcomes [10][11][12]. Self-management involves a patient taking an active role in managing their condition and its symptoms, typically with support from health professionals, and includes activities such as symptom monitoring, patient education, goal setting, and reviewing progress [11,13,14].…”

“…Self-management is increasingly being recognised as an invaluable rehabilitation tool for patients managing chronic illnesses or conditions with extended recovery periods and has been shown to improve health outcomes [10][11][12]. Self-management involves a patient taking an active role in managing their condition and its symptoms, typically with support from health professionals, and includes activities such as symptom monitoring, patient education, goal setting, and reviewing progress [11,13,14]. Self-management can also be delivered partially or fully online, a convenient and increasingly important option since the onset of the COVID-19 pandemic [15].…”