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

• Published in: NPJ primary care respiratory medicine 2016-09, Vol.26 (1), p.16051-16051, Article 16051
• Main Authors: Brien, Sarah B, Lewith, George T, Thomas, Mike
• Format: Article
• Language: English
• Subjects: 692/1807/1809; 692/699/1785/4037; Adaptation, Psychological; Adult; Aged; Aged, 80 and over; Female; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Pneumology/Respiratory System; Primary Care Medicine; Pulmonary Disease, Chronic Obstructive - psychology; Qualitative Research; Quality of Life - psychology; Severity of Illness Index; Thoracic Surgery
• ISSN: 2055-1010; 2055-1010
• DOI: 10.1038/npjpcrm.2016.51

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. Chronic obstructive pulmonary disease: How coping strategies affect patient experience Patients who adapt well to living with chronic obstructive pulmonary disorder (COPD) are more likely to have improved quality of life. Sarah Brien from Southampton General Hospital and colleagues interviewed 34 participants with COPD of varying severity and varying quality of life (QoL). Identifying four themes (disease impact, coping strategies, coping challenges and support needs), the team found that individuals successfully employing c