Needs' Assessment of Self-Management With Chronic Obstructive Pulmonary Disease

Introduction: Chronic obstructive pulmonary disease (COPD) is a widespread chronic disorder among middle- and older-aged individuals. COPD is the third leading cause of morbidity and mortality worldwide and is ranked as the seventh leading cause of death in Taiwan. It is not a fully irreversible disease. Effective disease management should be aimed at supportive care and disease self-management. Disease self-management, which teaches patients the skills and behaviors needed to manage their disease successfully, is becoming increasingly important in the treatment of COPD. Most studies have focused on outcomes of COPD self-management programs; few have assessed patients’ needs. Effective and satisfying patient education must include not only the content, which educators believe is necessary for disease self-management, but also the information the patient values and needs. Therefore, understanding the COPD patients’ needs is an important issue for nursing care.

Purpose: This study’s aim was to understand the needs and influential factors of self-management for COPD patients.

Methods: This study used a qualitative descriptive interview design. Participants with COPD of various severities were recruited by convenience sampling. Interview data were collected in the thoracic outpatient department and pulmonary rehabilitation room of a medical center in northern Taiwan. The first author conducted semi-structured, face-to-face interviews. We used the PRECEDE-PROCEED model to guide understanding the needs and influential factors of self-management behaviors for COPD participants. The interview began with general questions (e.g. “Could you describe your symptoms when you have an episode?”), followed by more specific questions (e.g. “Which factors may be an impediment when you exercise or perform daily activities?”). Miles and Huberman’s method was used to analyze the data, which consists of three steps: data coding, data display, and drawing and verifying conclusions.

Results: A total of 20 patients with COPD, all male, participated in this study. The mean age was 75.70years (SD ± 5.75); most (95%) lived with their spouse or children and nearly 55% were self-care. All participants had a history of smoking; 75% no longer smoked. The mean time since diagnosis of COPD was nearly 82 months (SD ± 66.55). Severity of disease varied: 15% mild, 25% moderate, 30% severe and 5% very severe. There was no pulmonary function test for one participant either 6-months before or after the interview. Spirometer results were normal for 20% of participants (forced expiratory volume in 1 second/ forced vital capacity ≧ 0.70), a diagnosis of COPD by the doctors was confirmed by the presence of a history of smoking, presenting symptoms (e.g., dyspnea of exertion, chronic cough, sputum production etc.), exercise limitations, and physical assessment. Participants’ perception of disease severity was 3.45 (SD ± 2.35; range 0-10).

Analysis of interview data resulted in nine themes, which described the needs of disease self-management: managing symptoms, managing medications, emotional adjustment, healthy eating, promoting sleep quality, maintaining a healthy life, quitting smoking, preventing catching a cold, and preventing falling. Three influential factors influenced the needs of self-management: predisposing factors, enabling factors, and reinforcing factors. Predisposing factors included patient knowledge about COPD, motivation of self-care, self-perception of disease severity and presence of other chronic diseases. Enabling factors included time required to travel to the hospital. Reinforcing factors included support (from family, friends, healthcare professionals) and self-perception of medical outcomes.

Conclusion: Our findings provide a better understanding of the needs and influential factors of self-management for COPD patients. Although a patient’s perspectives of the needs for disease self-management may differ from healthcare professionals, the patient should be considered the expert in terms of what is important in their life. Thus, a patient-centred perspective calls for the investigation of self-management needs as a means for developing self-management programs targeted to the unique requirements of each patient, in order to enhance the quality of life for patients with COPD.

The PRECEDE-PROCEED model guided researchers to understand that many factors affected the selection of self-management behaviors for the participants with COPD, including disease-related knowledge about COPD, self-perception of disease severity and medical outcomes, and physical-psychological-social factors. Pulmonary rehabilitation has been shown to be the most effective therapeutic strategy to improve health status, activity tolerance, and quality of life. The mean age of participants in our study was 75.70, which is similar to other studies conducted on patients in Taiwan. Older patients with COPD in Taiwan are often more dependent on their caregiver or families when they travel to hospital to participate in rehabilitation, suggesting that families play a key role in motivating patients to attend healthcare programs. A patient-centred program of disease self-management should not only focus on patients’ health problems and psychological distress, but also on educating family members about the benefits of self-management.