Department of Medicine, University of Otago, Wellington, New Zealand.
Te Whatu Ora Capital, Coast and Hutt Valley, Wellington, New Zealand.
Int J Chron Obstruct Pulmon Dis. 2023 Mar 2;18:207-218. doi: 10.2147/COPD.S393645. eCollection 2023.
Current guidelines for prevention of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) reflect clinical understanding of the causes of exacerbations but with a limited recognition of person-specific contributing factors. As part of a randomized trial of a person-centered intervention aiming to promote self-determination, we describe personal perspectives of those with chronic obstructive pulmonary disease (COPD) on what they saw as the causes and best ways to stay well and prevent rehospitalization after an AECOPD.
Twelve participants (mean age 69.3 years, six female, six male; eight New Zealand European, two Māori, one Pacific, and one other) were interviewed about their experiences of staying well and out of hospital. Data were collected via individual semi-structured interviews one year following an index hospital admission for AECOPD and focused on the participants' views and experiences of their health condition, their beliefs about staying well, and the causes of and factors preventing further exacerbations and hospitalizations. Data were analyzed using constructivist grounded theory methods.
Three main themes were identified that described participants' views on what helped or hindered them to stay well and out of hospital: 1) : The importance of having a positive mindset; 2) : Practical steps to reduce the risk of, and consequences from, episodes of AECOPD; and 3) : Feeling in command of one's life and health. Each of these was affected by : The influence of significant others, particularly close family.
This research expands our understanding of how patients manage COPD and adds patient perspectives to current knowledge on how to prevent recurrent AECOPD. Programs which promote self-efficacy and positivity would be beneficial additions to AECOPD prevention strategies, as could the inclusion of family or significant others in wellbeing plans.
慢性阻塞性肺疾病（COPD）急性加重（AECOPD）的预防指南反映了临床对加重原因的理解，但对个体相关因素的认识有限。作为一项旨在促进自主决策的以患者为中心的干预措施的随机试验的一部分，我们描述了 COPD 患者对他们认为导致 AECOPD 后保持健康和预防再住院的原因以及最佳方法的个人观点。
12 名参与者（平均年龄 69.3 岁，6 名女性，6 名男性；8 名新西兰欧洲人，2 名毛利人，1 名太平洋岛民，1 名其他族裔）接受了有关保持健康和避免住院的个人经历的采访。数据通过个体半结构化访谈收集，在因 AECOPD 住院后的一年进行，重点关注参与者对自己健康状况的看法和经验、他们对保持健康的信念，以及导致进一步加重和住院的原因和预防因素。使用建构主义扎根理论方法进行数据分析。
确定了三个主要主题，描述了参与者对有助于或阻碍他们保持健康和避免住院的看法：1）积极心态的重要性；2）降低 AECOPD 发作风险和减轻其后果的实用步骤；3）掌控自己的生活和健康的感觉。这些主题都受到了：重要他人（特别是亲密家人）的影响。
这项研究扩展了我们对患者如何管理 COPD 的理解，并为如何预防复发性 AECOPD 增加了患者的观点。促进自我效能感和积极性的计划将是 AECOPD 预防策略的有益补充，将家人或重要他人纳入健康计划也可能有所帮助。
