Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Pulmonary Department, Reykjalundur Rehabilitation Center, Mosfellsbaer, Iceland.
Int J Chron Obstruct Pulmon Dis. 2022 May 2;17:977-991. doi: 10.2147/COPD.S356107. eCollection 2022.
This phenomenological study was aimed at exploring principal physicians' (participants') experience of attending to COPD patients and motivating their self-management, in light of the GOLD clinical guidelines of COPD therapy.
Interviews were conducted with nine physicians, who had referred patients to PR, five general practitioners (GPs) and four lung specialists (LSs). The interviews were recorded, transcribed, and analyzed through a process of deconstruction and reconstruction.
The participants experienced several ethical dilemmas in being principal physicians of COPD patients and motivating their self-management; primarily in the balancing act of adhering to the Hippocratic Oath of promoting health and saving lives, while respecting their patients' choice regarding non-adherence eg, by still smoking. It was also a challenge to deal with COPD as a nicotine addiction disease, deal with patients' denial regarding the harm of smoking and in motivating patient mastery of the disease. The participants used various strategies to motivate their patients' self-management such as active patient education, enhancing the patients' inner motivation, by means of an interdisciplinary approach, involving the patients' significant other when appropriate, and by proposing PR.
The findings indicate that being a principal physician of COPD patients and motivating their self-management is a balancing act, involving several dilemmas. Patients' nicotine addiction and physicians' ethical obligations are likely to create ethical dilemmas as the physician is obligated to respect the patients' will, even though it contradicts what is best for the patient. The participants suggest strategies to motivate COPD patients' self-management.
本现象学研究旨在探讨主要医师（参与者）在 COPD 治疗 GOLD 临床指南的指导下，照顾 COPD 患者并激励其自我管理的体验。
对 9 名曾将患者转诊至 PR 的医师、5 名全科医生（GP）和 4 名肺病专家（LS）进行了访谈。对访谈进行了记录、转录，并通过解构和重构的过程进行了分析。
参与者在作为 COPD 患者的主要医师并激励其自我管理方面经历了一些伦理困境；主要是在遵守希波克拉底誓言促进健康和拯救生命与尊重他们的患者不遵守的选择之间的平衡，例如仍吸烟。将 COPD 视为尼古丁成瘾性疾病、处理患者对吸烟危害的否认以及激励患者掌握疾病也具有挑战性。参与者使用了各种策略来激励患者的自我管理，例如积极的患者教育、通过跨学科方法增强患者的内在动机、在适当的情况下让患者的重要他人参与进来，并提出 PR。
研究结果表明，作为 COPD 患者的主要医师并激励其自我管理是一种平衡行为，涉及到几个困境。患者的尼古丁成瘾和医生的道德义务可能会造成伦理困境，因为医生有义务尊重患者的意愿，即使这与对患者最有利的情况相矛盾。参与者提出了激励 COPD 患者自我管理的策略。
