Centre for Exercise & Rehabilitation Science (CERS), NIHR Leicester BRC (Respiratory), Glenfield Hospital, Leicester, UK.
Department of Respiratory Sciences, University of Leicester, University Road, Leicester, UK.
NPJ Prim Care Respir Med. 2022 Jun 29;32(1):23. doi: 10.1038/s41533-022-00285-9.
Pulmonary rehabilitation (PR) is highly evidenced but underutilised in patients living with chronic obstructive pulmonary disease (COPD). A menu of centre and home-based programmes is available to facilitate uptake but is not routinely offered. An appraisal of the current PR referral approach compared to a menu-based approach was warranted to explore the decision-making needs of patients living with COPD when considering a referral to PR. Face-to-face or telephone, semi-structured interviews were conducted with patients diagnosed with COPD and referred to PR and referring HCPs. Interviews were audio-recorded, transcribed verbatim and analysed using the enhanced critical incident technique. 14 HCPs and 11 patients were interviewed (n = 25). Interview data generated 276 critical incidents which informed 28 categories (30 sub-categories). Five high-level themes captured patients' decision-making needs for PR: Understanding COPD, understanding PR, perceived ability to access PR, a desire to accept PR, and supporting the offer. A menu-based approach would further support patients' PR decision-making, however, insufficient knowledge of the programmes would limit its perceived feasibility and acceptability. The development of shared decision making interventions (e.g., a patient decision aid) to elicit patient-centred, meaningful discussions about the menu is suggested.
肺康复（PR）在慢性阻塞性肺疾病（COPD）患者中的应用虽然有充分的证据支持，但仍未得到充分利用。有一系列中心和家庭为基础的方案可供选择，以促进接受度，但通常不提供。有必要评估当前的 PR 转诊方法与基于菜单的方法，以探讨 COPD 患者在考虑 PR 转诊时的决策需求。对已被诊断为 COPD 并被转诊至 PR 且有转诊 HCP 的患者进行面对面或电话、半结构化访谈。对访谈进行录音、逐字转录，并使用增强型关键事件技术进行分析。共访谈了 14 名 HCP 和 11 名患者（n=25）。访谈数据产生了 276 个关键事件，这些事件提供了 28 个类别（30 个子类别）。五个高级别主题捕捉到了患者对 PR 的决策需求：了解 COPD、了解 PR、感知获得 PR 的能力、接受 PR 的愿望以及支持提供 PR。基于菜单的方法将进一步支持患者的 PR 决策，但对这些方案的了解不足将限制其感知的可行性和可接受性。建议制定共同决策干预措施（例如，患者决策辅助工具），以引出以患者为中心的、关于该菜单的有意义的讨论。
