Roucoux Guillaume, Scanferla Elisabetta, Delorme Mathieu, Fraticelli Laurie, Kiakouama Maleka Lize, Nocent-Ejnaini Cécilia, Ozier Annaig, Patout Maxime, Le Rouzic Olivier, Zysman Maéva
Independent researcher, Paris, France
Paris Cité University, Paris, Île-de-France, France.
BMJ Open Respir Res. 2025 Jan 22;12(1):e002708. doi: 10.1136/bmjresp-2024-002708.
Chronic obstructive pulmonary disease (COPD) is a common treatable disease often diagnosed in patients with risk factors after a prolonged period with suggestive symptoms. Our qualitative study aimed to identify barriers to establishing diagnosis in the natural history of this condition.
An inductive thematic analysis was performed on structured interviews with patients, general practitioners (GPs) and pulmonologists in France. Inclusion depended on criteria to generate two purposive samples (patients and physicians). Recruitment occurred online. Data collection proceeded until 15 patients and 15 physicians (eight pulmonologists, seven GPs) were interviewed. Data saturation was checked and achieved. The interviews were transcribed and coded in NVivo and triangulated between two researchers. The article respects the consolidated criteria for reporting qualitative research guidelines.
Three phases in the patients' clinical pathway to diagnosis and 12 barriers were found: Phase 1 (symptoms before consultation; n=4), lack of COPD knowledge, symptom denial, fear of lung cancer, and delayed general practice consultations; Phase 2 (primary care; n=3), letting bronchitis become chronic, priority to diseases with similar symptoms and/or more serious diseases, lack of COPD screening devices, time and curative treatments; Phase 3 (specialised medicine; n=5), treatment before diagnosis, late referral to pulmonologists, difficulty in accessing specialists and examination results, patient's reluctance to undergo further examinations, and need for additional tests to confirm a diagnosis.
People unaware of their COPD condition can encounter up to 12 barriers, which may combine before obtaining a formal diagnosis. Patients, GPs, pulmonologists and the state health authorities share responsibility for addressing these barriers and enhancing the care pathway.
慢性阻塞性肺疾病（COPD）是一种常见的可治疗疾病，常在有危险因素的患者出现提示性症状很长时间后才被诊断出来。我们的定性研究旨在确定在这种疾病的自然病程中建立诊断的障碍。
对法国的患者、全科医生（GP）和肺病专家进行结构化访谈，并进行归纳主题分析。纳入取决于生成两个有目的样本（患者和医生）的标准。通过在线方式进行招募。持续收集数据，直到采访了15名患者和15名医生（8名肺病专家，7名全科医生）。检查并实现了数据饱和。访谈内容被转录并在NVivo中编码，由两名研究人员进行三角验证。本文遵循报告定性研究指南的综合标准。
发现了患者诊断临床路径的三个阶段和12个障碍：第一阶段（就诊前症状；n = 4），缺乏COPD知识、否认症状、恐惧肺癌以及延迟进行全科诊疗；第二阶段（初级保健；n = 3），让支气管炎发展为慢性、优先处理症状相似和/或更严重的疾病、缺乏COPD筛查设备、时间和治愈性治疗；第三阶段（专科医学；n = 5），诊断前治疗、转诊至肺病专家较晚、获取专家和检查结果困难、患者不愿接受进一步检查以及需要额外检查来确诊。
未意识到自己患有COPD的人可能会遇到多达12个障碍，这些障碍可能在获得正式诊断之前就会综合出现。患者、全科医生、肺病专家和国家卫生当局共同负责解决这些障碍并改善护理路径。
