Patient coping strategies in COPD across disease severity and quality of life: a qualitative study

Abstract

Quality of life (QoL) has a weak relationship with lung function (LF) impairment in COPD; some cope well despite poor LF, whereas others suffer disproportionate QoL impairment despite well-preserved LF. Adjuvant non-pharmacological interventions such as rehabilitation and psychological/behavioural support may help if acceptable and targeted appropriately, but they are under-used and sometimes declined by patients. This study aimed to explore and understand variations in experiences and coping strategies in patients with different severities of disease and disease-specific QoL. Thirty-four participants were purposively sampled across a spectrum of LF and QoL impairment, to cover a grid of sub-groups (‘very severe LF, good QoL’, moderate LF, poor QoL’ and so on). Semi-structured interviews, digitally recorded, were analysed by thematic analysis. Data saturation was achieved. Four themes emerged: symptom impact, coping strategies, coping challenges and support needs. Most of them described using multiple coping strategies, yet over half reported significant challenges coping with COPD, including psychological impact, non-acceptance of diagnosis and/or disease progression, effects of co-morbidities and inadequate self-management skills. Approximately half of the participants wanted further help, ideally non-pharmacological, across all LF impairment groups but mainly with lower QoL. Those with lower QoL additionally reported greater psychological distress and greater use of non-pharmacological support strategies where accessible. Patients who develop effective coping strategies have a better QoL independent of objective LF, whereas others cope poorly, are aware of this and report more use of non-pharmacological approaches. This study suggests that severely impaired QoL, irrelevant of lung function, is a powerful patient-centred indication to explore the positive benefits of psychological and behavioural support for distressed COPD patients.

Perception of symptoms and quality of life – comparison of patients’ and physicians’ views in the COPD MIRROR study

“… 6 Psychological and behavioral factors may influence individual perceptions of symptom severity, and strategies used by patients to cope with the burden of symptoms and disability are still incompletely understood. 7 Several studies 1 , 10 , 13 have conducted surveys pairing patients with the doctors taking care of them and have observed differences in the way the disease is perceived. However, a limiting factor is that different questionnaires have been used for the two groups.…”

Care bundles to reduce re-admissions for patients with chronic obstructive pulmonary disease: a mixed-methods study

“…These findings have been echoed more recently in qualitative studies of patients' experiences of living with COPD by Marx et al 48 and Brien et al 49 Drawing out the implications for health care, Marx et al 48 concluded that patients may benefit from the early integration of palliative care in care systems, to help them to understand and accept their life situation and enhance their reduced quality of life. The authors argued that the multidisciplinary nature of palliative care, including psychological support and volunteer work, may help to address patients' psychosocial needs.…”

“…The authors argued that the multidisciplinary nature of palliative care, including psychological support and volunteer work, may help to address patients' psychosocial needs. Brien et al 49 examined experiences of COPD in patients with varying quality of life. Most patients used multiple coping strategies, yet over half reported significant challenges coping with COPD.…”

COPD stands for complex obstructive pulmonary disease

“…Indeed, acceptance of the disease is associated with behaviour change [26]. Furthermore, acceptance of the diagnoses and limitations, having a realistic disease understanding and developing a rational response to the disease are ways of enabling taking control [69]. Another considerable outcome is emotional intelligence, i.e.…”