Case-finding for COPD in primary care: a qualitative study of patients’ perspectives

Abstract

BackgroundCOPD is a leading cause of morbidity and mortality, yet it remains largely under-diagnosed. Case-finding is encouraged by many professionals, but there is a lack of information on the patients’ views and perspectives.Patients and methodsSemistructured interviews were conducted with adults, aged 40 years or older with a history of smoking, who were eligible and invited for case-finding for COPD as a part of a large UK primary care trial. Patients, including those who consented or declined participation and those with and without COPD after screening, were interviewed. Interviews were transcribed and analyzed using the framework method.ResultsThe 43 interviews revealed the following two main categories of themes: patients’ views on COPD case-finding and barriers to case-finding. Overall, case-finding was deemed important and beneficial. Participants highlighted the need for screening activities to be convenient for patients but perceived that general practitioners (GPs) lacked the time and accessing appointments was difficult. Desire for a health check among symptomatic patients facilitated participation in case-finding. Psychological barriers to engagement included denial of ill health or failure to recognize symptoms, fear of the “test”, and lung symptoms being low on the hierarchy of patient health complaints. Mechanical barriers included providing care for another person (and therefore being too busy), being unable to access GP appointments, and lacking feedback of spirometry results or communication of the diagnosis.ConclusionPatient engagement with case-finding may be limited by denial or lack of recognition of symptoms and physical barriers to attendance. Increasing public awareness of COPD risk factors and early symptoms may enhance case-finding.

Specialist respiratory outreach: a case-finding initiative for identifying undiagnosed COPD in primary care

“…Possible reasons for the low response rate in our research may be due to denial of symptoms particularly if the symptoms are mild and not limiting daily activities. People may also avoid addressing their lung health due to the potential stigma of having a chronic lung disease caused by their tobacco dependency 42 , 43 . Potential cost implications such as an increase in life and travel insurance, as well as the cost of prescriptions may also be a factor to decline participation 44 .…”

Impact of COPD case finding on clinical care: a prospective analysis of the TargetCOPD trial

“… 18 A qualitative study with patients also found that GPs often lack the time to engage in case finding, that accessing primary care appointments can be difficult, and that communication about a diagnosis can often be lacking. 19 In addition, patients may occasionally be in denial of their respiratory symptoms or may not prioritise this over other health issues. Case finding strategies will therefore need to address patient education on accessing health services more promptly for respiratory symptoms.…”

Egy oktatóprogram fejlesztésének lehetőségei tüdőgyógyász szakorvosok krónikus obstruktív tüdőbetegséggel kapcsolatos megítélése alapján

“…Két interjúalany visszakapcsol az orvosi kommunikációhoz: az orvos küldjön pozitív visszajelzést, ha ezek bármelyike megtörtént, "ünnepelje a beteget". Az esélyadás kétoldalú: ha a beteg elfogadja a betegségét, és elhiszi, hogy az inhalátor tud neki segíteni, akkor ez már az első lépés a gyógyulás felé vezető úton [21]. A rehabilitációban való részvétel és az eredmények mindennapokba ültetése pedig megalapozza ennek a hosszú távú sikerét [22].…”