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Potential triggers for the holistic assessment of people with severe chronic obstructive pulmonary disease: analysis of multiperspective, serial qualitative interviews

Cawley, D., Billings, J., Oliver, D., Kendall, M., Pinnock, H. (2014) Potential triggers for the holistic assessment of people with severe chronic obstructive pulmonary disease: analysis of multiperspective, serial qualitative interviews. BMJ Supportive & Palliative Care, 4 (2). pp. 152-160. ISSN 2045-435X. E-ISSN 2045-4368. (doi:10.1136/bmjspcare-2013-000629) (Access to this publication is currently restricted. You may be able to access a copy if URLs are provided) (KAR id:38985)

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Abstract

Objectives: This study explores the narrative accounts of chronic obstructive pulmonary disease (COPD) to identify events that potentially could act as triggers for provision of supportive

and palliative care. Trigger events must have meaning for the patient/carer, be visible to professionals, and have value in provoking useful actions.

Methods: A purposive sample of people with severe COPD, and their informal and professional carers, was recruited from primary/secondary care in Scotland. Indepth participant-led interviews allowed people to tell their illness story. Events occurring throughout the individual’s account of the COPD journey were identified, and analysed thematically with regard to the meaning, visibility and use as potential

triggers.

Results: Events identified from 92 transcripts (21 patients, 13 family carers, 18 professionals) punctuated the disease trajectory and crossed multiprofessional boundaries of care. These

reflected advancing disease (increasing carer burden, becoming housebound, appointment frequency, increasing burden of disease, shifting priorities of care) or were an intervention addressing the consequences of advancing disease (requesting disabled parking, home adaptations, hospital admissions). Despite being meaningful in terms of increasing disability, many were invisible to professionals. Others were isolated events symptomatic of wider, ongoing disability which could potentially have use as triggers.

Conclusions: Meaningful events can be identified within the story of COPD which reflect wider needs, are clearly visible to alert professionals, and be of use in terms of potentially guiding supportive interventions. To achieve this level of usefulness, services will need to promote health and social care integration with clear processes to facilitate holistic

assessment when a trigger is detected.

Item Type: Article
DOI/Identification number: 10.1136/bmjspcare-2013-000629
Uncontrolled keywords: COPD, triggers, palliative care
Subjects: R Medicine > RC Internal medicine
Divisions: Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research
Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research > Centre for Health Services Studies
Depositing User: Jennifer Billings
Date Deposited: 31 Mar 2014 11:02 UTC
Last Modified: 29 Oct 2021 14:37 UTC
Resource URI: https://kar.kent.ac.uk/id/eprint/38985 (The current URI for this page, for reference purposes)
Billings, J.: https://orcid.org/0000-0002-5660-9478
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