Support for older people with COPD in community settings: a systematic review of qualitative research.
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KIRKPATRICK, P., WILSON, E. and WIMPENNY, P., 2012. Support for older people with COPD in community settings: a systematic review of qualitative research. JBI Database of Systematic Reviews and Implementation Reports, 10 (57), pp. 3649-3763.
Background- There are an estimated three million people affected by Chronic Obstructive Pulmonary Disease (COPD) in the UK with only about 900,000 of these being diagnosed according to the Healthcare Commission, and prevalence is increasing. Significant progress has been made in respect of treatment and management of the disease. However, there is limited evidence related to the perspective of those with COPD despite an acknowledgement that lung function, as determined by spirometry, does not necessarily equate with pulmonary disease5 and subsequent functional level or disability. The impact of COPD on patients, their family, carers and healthcare services demands that better ill health prevention and disease maintenance strategies be employed. Objective - The objective was to explore the common and shared experiences of those in caring partnership for patients with COPD receiving care and support in their community. Concept of support - For this review, the definition of support takes the view that support relates to ‘any activity or intervention aimed at improving or maintaining the health status of a patient with COPD’. Inclusion Criteria Types of participants - The review focused on the experiences of patients, carers, family members, nurses and doctors involved in providing support to patients with COPD in their own home. Patients aged 65 years and over were included. Phenomena of Interest - The review considered studies that represented patient, carer, nursing and medical staff experiences and perceptions of support relating to COPD. Types of studies - The review considered evidence from qualitative research including phenomenology, grounded theory, and descriptive studies, where support for COPD in a community context was the focus. Search Strategy – The search set out to find published studies in English from 1990-2010. Methodological Quality - The studies were appraised and findings extracted using the JBI critical appraisal tool for qualitative research. Three reviewers appraised the studies independently. 73 studies were critically appraised and 39 met the inclusion criteria. Data Synthesis – Findings from included papers were aggregated, categorised and synthesised. Results – Three syntheses were extracted from the categorised findings: Consistency of service provision - If those with COPD received more consistent support in relation to information, rehabilitation, end of life care and other service provision then their quality of life could be enhanced Home based care - Better planned and more integrated support for home based care around self-care/management and in managing exacerbations can reduce patient and carer anxiety and distress related to COPD Individualisation of care - Individualisation of care, which is not based on the patient’s ‘disease state’ (i.e. physical parameters) but on assessed need, is a necessary part of care for those with COPD. Implications for Practice • All older patients with COPD should have a patient held Management Plan • Because of the growing population of people with COPD it would appear appropriate from the evidence presented in the review of a need to upskill community staff, according to local need (multidisciplinary), in terms of assessment, monitoring and planning, rather than seeking to just provide specialist services. • Nursing education that includes skills training and pays attention to attitudes, expectations and perceived therapeutic usefulness of support for those with COPD is essential. • Increase community availability and access to pulmonary rehabilitation programmes to optimise quality of life. Implications for Research • Explore the value of community/home based versus hospital based services/support and rehabilitation programmes • Determine the usefulness of nurse led clinics/services for those with COPD • Evaluate the place of self care management plans in preventing COPD exacerbations • Review community nursing assessment approaches for those with COPD • Determine approaches to anxiety and depression management in COPD • Establish the links between functional ability and impact on quality of life