Queen Mary University of London, London, UK.
University of Birmingham, Birmingham, UK.
BMC Health Serv Res. 2024 Aug 21;24(1):960. doi: 10.1186/s12913-024-11370-9.
Chronic obstructive pulmonary disease (COPD) is commonly associated with anxiety/depression which can affect self-management and quality of life. The TANDEM trial evaluated a cognitive behavioural approach intervention targeting COPD-related symptoms of anxiety and/or depression, comprising up to eight one-to-one sessions delivered by respiratory healthcare professionals prior to pulmonary rehabilitation (PR). The intervention showed no improvement in anxiety/depression or uptake/completion of PR. We present patient perspectives of the intervention to help understand these results.
Semi-structured individual interviews, using a semi-structured topic guide informed by Sekhon's Theoretical Framework of Acceptability, were conducted with 19 patients between September 2019 and April 2020. The interviews were audio-recorded, transcribed verbatim and analysed thematically.
The following could have limited the impact of the intervention: (1) The lives of patients were complex and commonly affected by competing comorbidities or other external stressors which they managed through previously adopted long-standing coping strategies. (2) Some patients were reluctant to talk about their mood despite the Facilitators' training and person centred-skills which aimed to enable patients to talk freely about mood. (3) The intervention handouts and 'home-practice' were perceived as helpful for some, but not suitable for all. (4) Many patients perceived improvements in their physical and mental health, but this was not sustained due to a mix of personal and external factors, and some did not perceive any benefits. (5) PR non-attendance/non-completion was a result of personal and PR service-related reasons. (6) Discussing COPD and mental health with the Facilitator was a novel experience. Many patients felt that TANDEM could be of benefit if it was offered earlier on/at different time points in the COPD illness journey.
We found the delivery of TANDEM prior to PR was not helpful for patients with advanced COPD often experiencing other comorbidities, and/or difficult personal/external events. These patients already utilised long-standing coping strategies to manage their COPD. Holistic interventions, that address the impact of COPD in relation to wider aspects of a patients' life, may be more beneficial.
ISRCTN Registry 59,537,391. Registration date 20 March 2017.
慢性阻塞性肺疾病（COPD）常伴有焦虑/抑郁，这可能会影响自我管理和生活质量。TANDEM 试验评估了一种针对 COPD 相关焦虑和/或抑郁症状的认知行为方法干预，包括由呼吸保健专业人员在肺康复（PR）之前提供多达 8 次一对一的治疗。该干预措施并未改善焦虑/抑郁或 PR 的参与度/完成度。我们介绍了患者对干预措施的看法，以帮助理解这些结果。
2019 年 9 月至 2020 年 4 月，我们对 19 名患者进行了半结构化的个体访谈，访谈采用了由 Sekhon 的可接受性理论框架启发的半结构化主题指南。访谈进行了录音，逐字记录，并进行了主题分析。
以下因素可能限制了干预措施的效果：（1）患者的生活复杂，常常受到其他共病或其他外部压力源的影响，他们通过以前采用的长期应对策略来应对这些问题。（2）尽管治疗师接受过培训并采用以人为本的技能，旨在使患者能够自由地谈论情绪，但有些患者还是不愿意谈论自己的情绪。（3）干预措施的讲义和“家庭作业”对一些人有帮助，但不适合所有人。（4）许多患者认为自己的身心健康有所改善，但由于个人和外部因素的综合影响，这种改善无法持续，有些人则认为没有任何益处。（5）PR 的不参与/未完成是由于个人和 PR 服务相关的原因。（6）与治疗师讨论 COPD 和心理健康是一种新的体验。许多患者认为，如果 TANDEM 在 COPD 疾病进展的早期/不同时间点提供，它可能会有所帮助。
我们发现，在 PR 之前提供 TANDEM 对患有晚期 COPD 的患者没有帮助，这些患者经常患有其他共病，或/和经历着困难的个人/外部事件。这些患者已经采用了长期的应对策略来管理自己的 COPD。可能更有益的是针对 COPD 对患者生活更广泛方面的影响的整体干预措施。
ISRCTN Registry，537391。注册日期 2017 年 3 月 20 日。
