AbstractIntroduction: Patients with COPD experience symptoms of breathlessness, fatigue, reduced mobility and disease related anxiety and depression which impacts upon their quality of life. Throughout disease progression into the palliative phase of COPD, these symptoms increase resulting in social isolation and increased dependence upon others. A holistic and consistent approach to palliative care within COPD remains absent with many patients’ continuing to have limited access to palliative care resources. Self-management enhancing interventions have been used successfully within earlier stages of disease progression and have the potential to impact upon the enhanced symptoms present for patients with COPD at the end of life. Therefore, the aim of this dissertation is to determine if the use of self-management interventions are a potential coping strategy for patients with COPD at the end of life.
Methods: A qualitative systematic review has been undertaken to gain the perspectives of patients, carers and healthcare professionals upon the use of self-management interventions for people with COPD at the end of life. 25 studies were identified for inclusion following the application of pre-defined inclusion and exclusion criteria. The review findings were analysed using a meta-ethnographical approach to create new concepts upon the use of self-management as a coping strategy for patients with COPD at the end of life.
Findings: The use of self-management as a coping strategy for patients with COPD at the end of life was found to be acceptable to patients and healthcare professionals, and was perceived as having a positive effect upon self-confidence and perceived ability to cope.
Considerations are required prior to implementation of interventions aimed at this cohort of patients including the potential non-acceptance of having COPD by patients. In turn, this affects the perceptions of healthcare professionals upon the patients desire to change behaviours. Healthcare professionals find patients with COPD at the end of life complex to manage and require further education and training upon how to facilitate behaviour change within the palliative phase of disease progression.
Patients with COPD at the end of life form dependence upon others therefore the use of self-management interventions alone would not be appropriate or realistic.
Conclusion: The use of self-management for patients with COPD at the end of life has the potential to impact upon their abilities to cope with the symptoms of advanced disease progression and improve their quality of life. Further work is required to consider a supported model of self-management for patients with COPD at the end of life to meet their physical, psychological and social needs.
|Date of Award||2018|
|Supervisor||Elizabeth Horton (Supervisor), Louise Sewell (Supervisor), Jane Coad (Supervisor) & Charlotte Emma Bolton (Supervisor)|