Maintenance of non-pharmacological strategies 6 months after patients with chronic obstructive pulmonary disease (COPD) attend a breathlessness service: a qualitative study

Luckett, T; Roberts, M; Swami, V; Smith, T; Cho, J-G; Klimkeit, E; Wheatley, JR

Maintenance of non-pharmacological strategies 6 months after patients with chronic obstructive pulmonary disease (COPD) attend a breathlessness service: a qualitative study

Luckett, T

Roberts, M Swami, V Smith, T Cho, J-G Klimkeit, E Wheatley, JR

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Publisher:: BMJ Journals
Publication Type:: Journal Article
Citation:: BMJ Open, 2021, 11, (5)
Issue Date:: 2021-05-13

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Field	Value	Language
dc.contributor.author	Luckett, T https://orcid.org/0000-0001-6121-5409
dc.contributor.author	Roberts, M
dc.contributor.author	Swami, V
dc.contributor.author	Smith, T
dc.contributor.author	Cho, J-G
dc.contributor.author	Klimkeit, E
dc.contributor.author	Wheatley, JR
dc.date.accessioned	2021-11-11T04:24:57Z
dc.date.available	2021-11-11T04:24:57Z
dc.date.issued	2021-05-13
dc.identifier.citation	BMJ Open, 2021, 11, (5)
dc.identifier.issn	2044-6055
dc.identifier.issn	2044-6055
dc.identifier.uri	http://hdl.handle.net/10453/151506
dc.description.abstract	Objectives This study aimed to explore the degree to which non-pharmacological strategies for chronic breathlessness are sustained 6 months after completing a breathlessness service in patients with chronic obstructive pulmonary disease (COPD), and patient perceptions regarding the need for ongoing support. Design A qualitative approach was taken using semistructured telephone interviews. Thematic analysis used an integrative approach. Setting The Westmead Breathlessness Service (WBS) trains patients with COPD to self-manage chronic breathlessness over an 8-week programme with multidisciplinary input and home visits. Participants Patients with moderate to very severe COPD who had completed the WBS programme 6 months earlier. Results Thirty-two participants were interviewed. One or more breathlessness self-management strategies were sustained by most participants, including breathing techniques (n=22; 69%), the hand-held fan (n=17; 53%), planning/pacing and exercise (n=14 for each; 44%) and strategic use of a four-wheeled walker (n=8; 25%). However, almost a third of participants appeared to be struggling psychologically, including some who had refused psychological intervention. A ‘chaos narrative’ appeared to be prevalent, and many participants had poor recall of the programme. Conclusions Self-management strategies taught by breathlessness services to patients with moderate to very severe COPD have potential to be sustained 6 months later. However, psychological coping may be more challenging to maintain. Research is needed on ways to improve resilience to set-backs and uptake of psychological interventions, as well as to understand and address the implications of poor recall for self-management. Trial registration number ACTRN12617000499381
dc.format	Electronic
dc.language	eng
dc.publisher	BMJ Journals
dc.relation.ispartof	BMJ Open
dc.relation.isbasedon	10.1136/bmjopen-2021-050149
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1103 Clinical Sciences, 1117 Public Health and Health Services, 1199 Other Medical and Health Sciences
dc.subject.mesh	Humans
dc.subject.mesh	Pulmonary Disease, Chronic Obstructive
dc.subject.mesh	Dyspnea
dc.subject.mesh	Adaptation, Psychological
dc.subject.mesh	Qualitative Research
dc.subject.mesh	Self-Management
dc.subject.mesh	Adaptation, Psychological
dc.subject.mesh	Dyspnea
dc.subject.mesh	Humans
dc.subject.mesh	Pulmonary Disease, Chronic Obstructive
dc.subject.mesh	Qualitative Research
dc.subject.mesh	Self-Management
dc.title	Maintenance of non-pharmacological strategies 6 months after patients with chronic obstructive pulmonary disease (COPD) attend a breathlessness service: a qualitative study
dc.type	Journal Article
utslib.citation.volume	11
utslib.location.activity	England
utslib.for	1103 Clinical Sciences
utslib.for	1117 Public Health and Health Services
utslib.for	1199 Other Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	open_access	*
pubs.consider-herdc	false
dc.date.updated	2021-11-11T04:24:56Z
pubs.issue	5
pubs.publication-status	Published
pubs.volume	11
utslib.citation.issue	5

Abstract:

Objectives This study aimed to explore the degree to which non-pharmacological strategies for chronic breathlessness are sustained 6 months after completing a breathlessness service in patients with chronic obstructive pulmonary disease (COPD), and patient perceptions regarding the need for ongoing support. Design A qualitative approach was taken using semistructured telephone interviews. Thematic analysis used an integrative approach. Setting The Westmead Breathlessness Service (WBS) trains patients with COPD to self-manage chronic breathlessness over an 8-week programme with multidisciplinary input and home visits. Participants Patients with moderate to very severe COPD who had completed the WBS programme 6 months earlier. Results Thirty-two participants were interviewed. One or more breathlessness self-management strategies were sustained by most participants, including breathing techniques (n=22; 69%), the hand-held fan (n=17; 53%), planning/pacing and exercise (n=14 for each; 44%) and strategic use of a four-wheeled walker (n=8; 25%). However, almost a third of participants appeared to be struggling psychologically, including some who had refused psychological intervention. A ‘chaos narrative’ appeared to be prevalent, and many participants had poor recall of the programme. Conclusions Self-management strategies taught by breathlessness services to patients with moderate to very severe COPD have potential to be sustained 6 months later. However, psychological coping may be more challenging to maintain. Research is needed on ways to improve resilience to set-backs and uptake of psychological interventions, as well as to understand and address the implications of poor recall for self-management. Trial registration number ACTRN12617000499381

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