意大利 COVID-19 对慢性阻塞性肺疾病患者、其照护者和医疗保健专业人员的影响的叙事分析。
Narrative Analysis of the Impact of COVID-19 on Patients with Chronic Obstructive Pulmonary Disease, Their Caregivers, and Healthcare Professionals in Italy.
机构信息
Healthcare Area, ISTUD Foundation, Milan, Italy.
Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.
出版信息
Int J Chron Obstruct Pulmon Dis. 2021 Jul 24;16:2181-2201. doi: 10.2147/COPD.S312372. eCollection 2021.
PURPOSE
The COVID-19 pandemic has disrupted many lives, including those of people suffering from chronic obstructive pulmonary disease (COPD) and their caregivers. The main aim of this study was to use narrative medicine, a validated approach promoting quality of care to explore how the COVID-19 pandemic impacted the quality of care, quality of life, psychological factors and social factors of people affected by COPD and their caregivers and healthcare professionals (HCPs). A secondary aim was to explore the role of telemedicine in combating isolation and providing access to care.
METHODS
A cross-sectional observational narrative medicine study was conducted between July and November 2020 across Italy. An online semi-structured questionnaire with a narrative plot was completed by 146 participants (79 COPD patients, 24 caregivers, and 43 HCPs). Narrations were analyzed with descriptive statistics and evaluated using NVivo 11 software to break down the text and identify recurring themes and major semantic clusters.
RESULTS
During the first lockdown, 58.22% of responses from COPD patients indicated terror, fear and/or apprehension; at reopening, this figure was 35.44%. Among caregivers, these figures were 100% at first lockdown and 45.83% at reopening. The metaphors most commonly used by patients to describe COPD and COVID-19 were monster and murderer, respectively. Patients described their homes more often as clean and lonely than as offering no shelter. The narratives of 42 COPD patients (45.2%) described coping. Only 12.6% of COPD patients reported regular access to medical visits during lockdown, while 59.1% of general practitioners and pulmonologists reported using telemedicine, which was perceived as satisfactory by both patients and caregivers.
CONCLUSION
It is relevant to aim for a multidisciplinary and multilevel system of care that empowers telemedicine and integrates specific psychological support programs for COPD patients and their caregivers.
目的
COVID-19 大流行扰乱了许多人的生活，包括慢性阻塞性肺疾病（COPD）患者及其照护者。本研究的主要目的是使用叙事医学，一种经过验证的促进护理质量的方法，探讨 COVID-19 大流行如何影响 COPD 患者及其照护者和医疗保健专业人员（HCP）的护理质量、生活质量、心理因素和社会因素。次要目的是探讨远程医疗在对抗隔离和提供护理方面的作用。
方法
2020 年 7 月至 11 月，在意大利进行了一项横断面观察性叙事医学研究。146 名参与者（79 名 COPD 患者、24 名照护者和 43 名 HCP）完成了一份带有叙事情节的在线半结构式问卷。使用描述性统计对叙事进行分析，并使用 NVivo 11 软件进行评估，以分解文本并识别反复出现的主题和主要语义群。
结果
在第一次封锁期间，58.22%的 COPD 患者的回答表示恐惧、害怕和/或担忧；在重新开放时，这一数字为 35.44%。在照护者中，这一数字在第一次封锁时为 100%，在重新开放时为 45.83%。患者用来描述 COPD 和 COVID-19 的最常见隐喻分别是怪物和凶手。患者更常将自己的家描述为干净和孤独，而不是没有庇护所。42 名 COPD 患者（45.2%）的叙述描述了应对方式。只有 12.6%的 COPD 患者报告在封锁期间定期接受医疗访问，而 59.1%的全科医生和肺病专家报告使用远程医疗，患者和照护者都认为这种方式令人满意。
结论
旨在建立一个多学科和多层次的护理系统，赋予远程医疗权力，并为 COPD 患者及其照护者整合特定的心理支持计划，这是很重要的。
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