Patient perspectives on the Tailored intervention for Anxiety and Depression Management in COPD (TANDEM): a qualitative evaluation

• Published in: BMC health services research 2024-08, Vol.24 (1), p.960-15
• Main Authors: Sohanpal, Ratna, Mammoliti, Kristie-Marie, Barradell, Amy, Kelly, Moira, Newton, Sian, Steed, Liz, Wileman, Vari, Rowland, Vickie, Dibao-Dina, Clarisse, Moore, Anna, Pinnock, Hilary, Taylor, Stephanie J C
• Format: Article
• Language: English
• Subjects: Adaptation, Psychological; Aged; Anxiety; Anxiety - therapy; Care and treatment; Chronic obstructive; Chronic obstructive pulmonary disease; Cognitive Behavioral Therapy - methods; Data analysis; Data collection; Depression; Depression - therapy; Depression, Mental; Diagnosis; Exercise; Female; Health services; Humans; Intervention; Interviews; Interviews as Topic; Lung diseases, Obstructive; Male; Mental depression; Mental health; Middle Aged; Patients; Physical fitness; Professionals; Psychological aspects; Psychological intervention; Pulmonary disease; Pulmonary Disease, Chronic Obstructive - psychology; Pulmonary Disease, Chronic Obstructive - therapy; Qualitative Research; Quality of Life; Researchers; Risk factors
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-024-11370-9

Chronic obstructive pulmonary disease (COPD) is commonly associated with anxiety/depression which can affect self-management and quality of life. The TANDEM trial evaluated a cognitive behavioural approach intervention targeting COPD-related symptoms of anxiety and/or depression, comprising up to eight one-to-one sessions delivered by respiratory healthcare professionals prior to pulmonary rehabilitation (PR). The intervention showed no improvement in anxiety/depression or uptake/completion of PR. We present patient perspectives of the intervention to help understand these results. Semi-structured individual interviews, using a semi-structured topic guide informed by Sekhon's Theoretical Framework of Acceptability, were conducted with 19 patients between September 2019 and April 2020. The interviews were audio-recorded, transcribed verbatim and analysed thematically. The following could have limited the impact of the intervention: (1) The lives of patients were complex and commonly affected by competing comorbidities or other external stressors which they managed through previously adopted long-standing coping strategies. (2) Some patients were reluctant to talk about their mood despite the Facilitators' training and person centred-skills which aimed to enable patients to talk freely about mood. (3) The intervention handouts and 'home-practice' were perceived as helpful for some, but not suitable for all. (4) Many patients perceived improvements in their physical and mental health, but this was not sustained due to a mix of personal and external factors, and some did not perceive any benefits. (5) PR non-attendance/non-completion was a result of personal and PR service-related reasons. (6) Discussing COPD and mental health with the Facilitator was a novel experience. Many patients felt that TANDEM could be of benefit if it was offered earlier on/at different time points in the COPD illness journey. We found the delivery of TANDEM prior to PR was not helpful for patients with advanced COPD often experiencing other comorbidities, and/or difficult personal/external events. These patients already utilised long-standing coping strategies to manage their COPD. Holistic interventions, that address the impact of COPD in relation to wider aspects of a patients' life, may be more beneficial. ISRCTN Registry 59,537,391. Registration date 20 March 2017.