NHLI, Airways Disease, Faculty of Medicine, Imperial College London, London, UK.
Royal Brompton and Harefield Hospitals Clinical Group of Guys and St Thomas' NHS Foundation Trust, London, UK.
Chron Respir Dis. 2023 Jan-Dec;20:14799731231198863. doi: 10.1177/14799731231198863.
Completion of pulmonary rehabilitation is recognised in chronic obstructive pulmonary disease (COPD) guidelines as a key opportunity to consider systematically whether a respiratory review to assess potential suitability for a lung volume reduction (LVR) procedure might be appropriate. We describe the development of a simple decision-support tool (the LVR-PR tool) to aid clinicians working in pulmonary rehabilitation, to operationalise this process.
We took an iterative mixed methods approach, which was partnership-based and involved an initial consensus survey, focus groups and an observational study cohort at multiple pulmonary rehabilitation centres.
Diagnosis (97%), exercise capacity (84%), breathlessness (78%) and co-morbidities (76%) were acknowledged to be essential items for assessing basic LVR eligibility. Collating prior investigations and assessing patient understanding were considered useful but not essential. Clinician concerns included; streamlining the tool; access to clinical information and investigations; and care needed around introducing LVR therapies to patients in a PR setting. Access to clearer information about LVR procedures, the clinician's role in considering eligibility and how educational resources should be delivered were identified as important themes from patient group discussions. The LVR-PR tool was considered to be feasible and valid for implementation in a variety of PR services across the UK subject to the provision of appropriate health professional training. Clinicians working in specialist LVR centres across the UK who were not otherwise involved in the development process confirmed the tool's validity using the content validity index (CVI).
The LVR-PR tool appears to be an acceptable tool that can be feasibly implemented in PR services subject to good quality educational resources for both patients and healthcare professionals.
在慢性阻塞性肺疾病（COPD）指南中，完成肺康复被认为是一个重要的机会，可以系统地考虑是否需要进行呼吸评估，以评估潜在的肺容积减少（LVR）手术适应证。我们描述了一种简单的决策支持工具（LVR-PR 工具）的开发，以帮助在肺康复中工作的临床医生实现这一过程。
我们采用了迭代混合方法，该方法基于合作，并涉及在多个肺康复中心进行初步共识调查、焦点小组和观察性研究队列。
诊断（97%）、运动能力（84%）、呼吸困难（78%）和合并症（76%）被认为是评估基本 LVR 资格的必要项目。汇集先前的调查并评估患者的理解被认为是有用的，但不是必需的。临床医生的关注点包括：简化工具；获取临床信息和调查；以及在肺康复环境中向患者介绍 LVR 治疗时需要的护理。从患者小组讨论中确定了与 LVR 程序更清晰的信息、临床医生在考虑资格方面的作用以及应如何提供教育资源相关的重要主题。LVR-PR 工具被认为在英国各种肺康复服务中具有可行性和有效性，但前提是提供适当的卫生专业人员培训。英国各地专门从事 LVR 中心的临床医生，他们没有参与该工具的开发过程，使用内容有效性指数（CVI）确认了该工具的有效性。
LVR-PR 工具似乎是一种可接受的工具，可以在肺康复服务中实施，但需要为患者和医疗保健专业人员提供高质量的教育资源。
