Lack of Referrals to Pulmonary Rehabilitation: Should we Pay Closer Attention to Healthcare Professionals’ Illness Perceptions?

Objective: Pulmonary rehabilitation (PR) is one of the most effective management strategies for patients with chronic obstructive pulmonary disease (COPD), however it is evident there are a lack of referrals to the programme. This study sought to establish healthcare professionals’ (HCPs) perceptions and understanding of PR and the perceived barriers and facilitators to referral. Design: This qualitative study adopted an interpretive phenomenological approach to explore participants lived experiences of PR. Methods: Purposeful recruitment of general practitioners, practice nurses, and doctors and nurses working on general medical wards took place. In-depth semi-structured interviews were conducted with 27 HCPs, which were recorded and transcribed verbatim. Interpretive phenomenological analysis was carried out to establish super-ordinate and sub-ordinate themes. Results: Three super-ordinate themes were identified: COPD Illness Perceptions, Pulmonary Rehabilitation Beliefs, and Organisational and Referral Pathway Perceptions. Many HCPs held views about the disease, some of which were stigmatising and impacted upon their decision to refer patients to PR. A lack of programme knowledge was evident, with some having never heard of PR or discussing limited exposure. This was often attributed to a lack of education during medical school or nursing degrees, and a lack of information provided from local services. Conclusions: Chance of referral appeared dependent on HCPs’ views of the programme and referral process, however one of the largest predictors appeared to be HCPs’ COPD illness perceptions. Although patient illness perceptions are commonly discussed within the literature, such association has not been made with HCPs and impact on referral to PR.