Narrative Analysis of the Impact of COVID-19 on Patients with Chronic Obstructive Pulmonary Disease, Their Caregivers, and Healthcare Professionals in Italy

Abstract

The COVID-19 pandemic has disrupted many lives, including those of people suffering from chronic obstructive pulmonary disease (COPD) and their caregivers. The main aim of this study was to use narrative medicine, a validated approach promoting quality of care to explore how the COVID-19 pandemic impacted the quality of care, quality of life, psychological factors and social factors of people affected by COPD and their caregivers and healthcare professionals (HCPs). A secondary aim was to explore the role of telemedicine in combating isolation and providing access to care. Methods: A cross-sectional observational narrative medicine study was conducted between July and November 2020 across Italy. An online semi-structured questionnaire with a narrative plot was completed by 146 participants (79 COPD patients, 24 caregivers, and 43 HCPs). Narrations were analyzed with descriptive statistics and evaluated using NVivo 11 software to break down the text and identify recurring themes and major semantic clusters. Results: During the first lockdown, 58.22% of responses from COPD patients indicated terror, fear and/or apprehension; at reopening, this figure was 35.44%. Among caregivers, these figures were 100% at first lockdown and 45.83% at reopening. The metaphors most commonly used by patients to describe COPD and COVID-19 were monster and murderer, respectively. Patients described their homes more often as clean and lonely than as offering no shelter. The narratives of 42 COPD patients (45.2%) described coping. Only 12.6% of COPD patients reported regular access to medical visits during lockdown, while 59.1% of general practitioners and pulmonologists reported using telemedicine, which was perceived as satisfactory by both patients and caregivers. Conclusion: It is relevant to aim for a multidisciplinary and multilevel system of care that empowers telemedicine and integrates specific psychological support programs for COPD patients and their caregivers.

Healthcare experience of adults with COPD during the COVID-19 pandemic: a rapid review of international literature

“…… I found a lot of availability at my pulmonologist, who continued to follow us by phone. Getting out of the house was tiring … 29 …”

“… 22 Patients appreciated the availability of a pulmonologist and the continuity of follow-up, and this was described as a positive patient experience by participants. 29 In contrast, cancelled appointments posed a major concern and presented as disruptions to care for participants, 18 32 while difficulties accessing healthcare services such as GPs and rehabilitation therapy left patients fearing disability. 2 …”

“…Several issues were reported regarding the comprehensiveness of services and care provided to adults with COPD during the pandemic due to the over-riding COVID-19 cases. Participants reported being denied care, 29 and fear of being denied care was a source of anxiety and stress for patients. 19 There were reports of reduced treatment options from respiratory specialists; however, there has been relatively little information published on continuity of care during the pandemic and papers had only explored this in the specialist care setting.…”

Postoperative pneumonia after bariatric surgery during the COVID-19 pandemic: a National Surgical Quality Improvement Program study

“…24 , 25 , 26 , 27 , 28 Patients with chronic respiratory conditions suffered disruptions in both appointments and pulmonary rehabilitation. 29 , 30 Patient habits changed as well, including increased rates of cigarette use. 31 In the post-operative patient, certain factors are known to be associated with decreased rates of pneumonia, such as early mobilization which was decreased during the pandemic as well as the increase rate of re-operations seen in our study which were associated with pneumonia development.…”

COPD and social distancing in the UK

“…It has been mentioned that individuals with COPD felt a higher need to self-isolate, which to some degree led to heightened emotions of loneliness (6). One study found extremely high prevalence of terror, fear and apprehension during a lockdown period (7). It has been identified that in particular the experiences of living through respiratory problems gave COPD patients an elevated level of anxiety, as lung impairment was frequently reported in COVID positive people (8).…”