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Abstract
Objectives To explore what it means for patients to live with chronic obstructive pulmonary disease (COPD) as an incurable and constantly progressing disease.
Design Qualitative longitudinal study using narrative and semistructured interviews. This paper presents findings of the initial interviews. Analysis using grounded theory.
Setting Lung care clinics and community care in Lower Saxony, Germany.
Participants 17 patients with advanced-stage COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) III/IV).
Findings Analysis shows that these patients have difficulties accepting their life situation and feel at the mercy of the disease, which could be identified as a core-experienced phenomenon. Over a long period of time, patients have only a vague feeling of being ill, caused by uncertain knowledge, slow progress and doubtful attribution of clinical symptoms of the disease (causal conditions). As an action strategy, patients try to maintain daily routines for as long as possible after diagnosis. Both effective standard and rescue medication, which helps to reduce breathlessness and other symptoms, and the feeling of being faced with one's own responsibility (intervening conditions) support this strategy, whereby patients' own responsibility is too painful to acknowledge. As a consequence, patients try to deny the threat to life for a long period of time. Frequently, they need to experience facing their own limits, often in the form of an acute crisis, to realise their health situation. The experience of the illness is contextualised by a continuous increase in limited mobility and social isolation.
Conclusion In order to help patients to improve disease awareness, to accept their life situation and to improve their reduced quality of life, patients may benefit from the early integration of palliative care (PC), considering its multiprofessional patient-centred and team-centred approach. Psychological support and volunteer work, which are relevant aspects of PC, should be appropriate to address psychosocial needs. More research is needed to evaluate how patients could benefit from early PC.
- QUALITATIVE RESEARCH
- Patients' Perspectives
- General Practice
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Footnotes
Contributors NS (director of the department of general practice, Hannover Medical School) was principal investigator of the study and led the study design and supervised the research process. FN (director of the department of palliative medicine, University Medical Center Göttingen) was co-investigator of the study and co-designed the study. GM (PhD, research associate) and HS (Dip, research associate) prepared the interview guide, recruitment and data collection. GM and MN (doctoral candidate) interviewed the participants. GM, MN, HS and SOB (MA, research associate) conducted the analysis and repeatedly discussed the findings. GM wrote the first draft. All authors critically reviewed and approved the final version.
Funding This study was supported by the Ministry of Science and Culture in Lower Saxony, Germany, grant number 74ZN1079.
Competing interests None declared.
Ethics approval The study received approval from the Ethics Committees of Hannover Medical School (registration number 5896) and University Medical Centre Göttingen (registration number 19/11/12).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.