Healthcare Professionals’ Perceptions of Pulmonary Rehabilitation as a Management Strategy for Patients with Chronic Obstructive Pulmonary Disease (COPD): An Interpretive Phenomenological Analysis

Abstract

Background: Sound evidence supports pulmonary rehabilitation (PR) as an effective management strategy for patients with respiratory disease, in particular chronic obstructive pulmonary disease (COPD). A multi-disciplinary programme, PR encompasses exercise training, education, nutritional advice, self-management and psychological support. Following PR patients often experience an increase in exercise capacity and quality of life, but a lack of referrals suggests that healthcare professionals (HCPs) are not ‘selling’ PR to patients. However, no evidence exists to fully substantiate this claim; a missing piece of the jigsaw. Objectives: 1. To explore HCPs’ perceptions regarding referral of COPD patients to PR in primary and secondary care settings. 2. To establish HCPs’ understanding of PR. 3. To explore barriers and facilitators to referral to PR. Methods: Interpretive phenomenological analysis (IPA) was adopted to establish HCPs’ perceptions of PR. Purposeful recruitment of general practitioners and practice nurses, and doctors and nurses working on general medical wards yielded a total of 27 participants. Informed consent preceded semi-structured interviews which were digitally recorded and transcribed verbatim. Findings: Three super-ordinate themes were identified: COPD Illness Perceptions, Pulmonary Rehabilitation Beliefs, and Organisational and Referral Pathway Perceptions. Commonalities and disparities were identified between primary and secondary care and amongst the different professional groups. HCPs held COPD illness perceptions; many held stigmatising beliefs in relation to the disease, which impacted upon referral practice. Pulmonary rehabilitation beliefs highlighted HCPs’ views on patient suitability and the PR programme. A lack of knowledge of PR and the referral process was evident. Organisational and referral pathway perceptions revealed barriers and facilitators to referral. 13 Conclusion: Referral to PR is as certain as spinning a wheel of fortune. Chance of referral appeared dependent upon individual HCPs, their perceptions of the programme, views of how COPD affects patients, and opinions of the referral process. All of these aspects, pieced together, could act as a predictor of referral practice. This is the first study to focus on HCPs’ perceptions of PR as a management strategy for patients with COPD and as such is a valuable contribution to knowledge

Date of Award	18 Oct 2018
Original language	English
Awarding Institution	Edge Hill University
Supervisor	CAROL KELLY (Director of Studies) & MARY O'BRIEN (Supervisor)