Encouraging attendance at pulmonary rehabilitation: a qualitative exploration

Abstract

PURPOSE: Chronic Obstructive Pulmonary Disease (COPD) is a limitation of airflow that leads to reduced participation in life. Pulmonary rehabilitation uses individually-tailored exercise and multidisciplinary education to help people manage their symptoms optimally and be as independent as possible. However, not all individuals referred to pulmonary rehabilitation participate. This qualitative study aimed to analyse patient views regarding attendance at pulmonary rehabilitation to explore influences on their decisions. RELEVANCE: Better understanding of influences on attendance at pulmonary rehabilitation will enable health professionals to take actions that increase the likelihood of participation; this will increase the numbers of individuals with COPD who take the opportunity to learn better ways of managing their condition. PARTICIPANTS: Individuals with COPD who were referred to a pulmonary rehabilitation service were invited to participate in a single interview prior to joining the programme. It was emphasised that their decision would not impact on any future treatment. Purposive selection of men and women ensured a variety of experiences. Five women and four men aged 59 to 82 completed interviews. All were white Caucasians living in Glasgow, Scotland. METHODS: The study was carried out within the framework of Interpretative Phenomenological Analysis. Semi-structured interviews (50-90 minutes) were carried out in participants' homes. A topic guide was developed to focus on experiences of COPD and views regarding future attendance at pulmonary rehabilitation. Ethical approval was granted by the Multi-Region Ethics Committee in Scotland. ANALYSIS: Transcribed interviews were analysed using the QSR N6 computer package. Two researchers were involved in developing themes, iteratively developing a classification or typology of views and experiences, progressing to locate relationships between themes. Three overarching master themes emerged. RESULTS: Master themes are labelled to reflect views or needs described by interviewees. The first describes contrasting experiences and attitudes: 'Exercise will kill me' versus 'I can't let it beat me.' Some individuals developed fear and avoidance of exercise, translating into wariness about attending pulmonary rehabilitation. Others refused to dwell on negative experiences,were determined to overcome symptoms, and expressed willingness to attend rehabilitation. The second master theme is called: 'A waste of my time' versus 'Doctors know best.' Participants with previous negative experiences of management often described low expectations of pulmonary rehabilitation. Others expressed faith in health professionals as a result of positive experiences, and were willing to follow their recommendations. The last theme was labelled: 'I want to walk and breathe better.' This reflects individuals' desire for professional advice and support in coping better with their condition. CONCLUSIONS: Individuals frequently recognise that they could be helped to cope better with their COPD symptoms. However,some fear that the burden of attending pulmonary rehabilitation will outweigh the benefits. IMPLICATIONS: It is important that the aims and content of pulmonary rehabilitation are carefully explained on referral in order to motivate patients and allay any fears. Positive and informative communications about pulmonary rehabilitation are likely to lead to increased uptake and benefit to more patients.