Disease self-management in patients with moderate COPD: a thematic analysis

Abstract

Background Treatment of patients with moderate chronic obstructive pulmonary disease (COPD) is challenged by the low priority of the disease by patients and general practitioners (GPs) affecting the extent of self-management. The aim of this study was to explore (i) attitudes to COPD self-management in patients with moderate COPD, (ii) perceptions of GP commitment to pulmonary rehabilitation in patients with moderate COPD, and (iii) COPD knowledge in patients with moderate COPD. Methods The study had a qualitative design using semi-structured interviews to explore the views of 14 patients diagnosed with moderate COPD. We applied strategic sampling to obtain maximum variation and conducted a thematic analysis of the data. Results Our main findings were that the degree of COPD self-management was linked to the resources of the informants. Further, the patients experienced that GPs only availed themselves of selected parts of the recommendations for COPD treatment by focusing on medical treatment and smoking cessation rather than physical activity and diet. Many patients lacked knowledge regarding the tolerated level of physical activity and therefore avoided activity increasing their heart rate. Finally, many patients were reluctant to accept the diagnosis because the disease is known to be self-inflicted. Conclusion Our study suggests that patients with moderate COPD need more information, especially regarding the positive effects of physical activity. GPs might need to devote more time to the three main elements of COPD treatment, smoking cessation, medical treatment, and physical activity, to promote self-management and a healthier lifestyle in patients with COPD.

Danish general practitioners’ management of patients with COPD: a nationwide survey

“…In our study, about half of the GPs stated that they, at least to some degree, needed educational support in COPD management. Similar studies show that some GPs stray from the guideline recommendations [10,11,13,14,27,28]. Our findings suggested variation according to the location; GPs from a rural area reported less need to consult a specialist than city GPs.…”

“…In this connection, 70% told their patients that a COPD rehabilitation program was available to them, and 62% reported that they believed to a high or very high degree that the patients benefit from such a program. In the present study, we were unable to assess the degree of patient involvement in these exchanges, but have described the patient perspective elsewhere [ 14 ].…”

“…We conducted a national cross-sectional web-based survey assessing GPs’ COPD management in Danish general practices. Data were generated in April–June 2019 as part of a larger study on perception and management of COPD [ 13 , 14 ]. On 24 April, a letter was sent by regular mail to the existing 1766 general practices, inviting approximately 3400 GPs to participate in this study.…”

“…Another possibility is that GPs' COPD knowledge could be insufficient [11,12]. Nevertheless, the low priority of COPD management can be attributed to both patients and healthcare professionals [12][13][14][15][16]. The patients seem to visit the GP too rarely [12,13,16] and the efforts made by the GPs seem inadequate [13][14][15][16].…”

Multicentre comparison of self-management in patients with COPD

“…This was the case in the present study where the HCJ recorded higher information needs for all LINQ domains, except smoking cessation. It has been reported that patients who consulted their general practitioners were dissatisfied with the treatment options available to them [ 15 ], namely that they were limited to medicine use and smoking cessation rather that pulmonary rehabilitation or other aspects of self-management. In our study, LINQ domain scores were low for the smoking and medication domains for all settings, despite a significant difference seen for the medication domain.…”