Exploring patients’ perceptions following an acute exacerbation of chronic obstructive pulmonary disease to inform tailored strategies to enhance pulmonary rehabilitation
thesisposted on 05.12.2014, 15:22 by Samantha Louise Harrison
Background: Patient attrition to Pulmonary Rehabilitation (PR) is significant. Whilst biomedical variables have been examined as potential predictors, their explanatory power is not substantial and increasingly psychological constructs have been considered as determinants of PR adherence. Aim: This thesis aimed to increase understanding of how PR can be facilitated and enhanced for patients following hospitalisation with an acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD) by exploring issues around patient access, engagement and assessment of psychological appraisals. Methods: An observational mixed-methods design was utilised informed by a review of the published literature and a retrospective observation of stable patients. Participants in the prospective studies had recently been hospitalised with an acute exacerbation of COPD. Qualitative component: Patients who refused a referral to PR participated in in-depth interviews exploring appraisals of an exacerbation. Transcripts were subjected to Interpretative Phenomenological Analysis. Quantitative component: Questionnaires relating to illness perceptions, mood, health status and self-efficacy were completed soon after hospital discharge. At six months acceptance and uptake of PR was documented. Cluster analysis was conducted using the domains of the Illness Perceptions Questionnaire-Revised. Results: Qualitative component: Conceptual themes included: ‘Construction of the self’, ‘Relinquishing control’ and ‘Engagement with others’. Quantitative component: Three distinct illness profiles exist in patients following an acute exacerbation of COPD: ‘in control’, ‘disengaged’ and ‘distressed’. There were no differences between ‘clusters’ in acceptance or uptake of PR. Conclusion: Adherence to post-exacerbation PR is poor and may reflect the intense emotional distress reported by patients following an acute exacerbation of COPD. Health care professionals need to be mindful of how they address patients who, during a period of vulnerability, are sensitive of perceived dismissive behaviour. Targeted psychological strategies which enhance partnership working and trust, address intense fear and elicit control may be beneficial in reducing distress and supporting uptake of PR.