Figures
- FIGURE 1
Process of developing the definition for a chronic obstructive pulmonary disease self-management intervention.
Tables
- TABLE 1
Characteristics of the 28 expert group members
Characteristics Age years 51.9±11.7 Males 17 (61) Country of work USA 8 (29) Canada 2 (7) Australia 4 (14) UK 7 (25) Netherlands 7 (25) Occupation# Medical practitioners 17 (61) Nurse 1 (4) Physiotherapists 4 (14) Psychologist 3 (11) Epidemiologist 8 (29) Medical researcher 10 (36) Work setting¶ Research 5 (19) Clinical 1 (4) Research and clinical 21 (78) Years of experience in COPD self-management research/care 14.5±7.0 Scientific skills+ 4 (3–5) Knowledge and/or clinical expertise regarding COPD self-management+ 4 (3–5) Data are presented as mean±sd, n (%) or median (interquartile range). COPD: chronic obstructive pulmonary disease. #: multiple answers were possible for each group expert member; ¶: 27 of 28 group members; +: 1=general, 5=highly specialised.
- TABLE 2
Proposed definitions in the five rounds of the process
Round Definition 1 (Initial) Self-management is a term applied to a structured, preferably patient-tailored, multifaceted programme that is directed towards change in health behaviour by training patients and equipping them with skills to both manage and cope with their COPD. The self-management programme requires at least an iterative process of interaction between the patient and healthcare provider that includes: 1) formulation of goals; 2) provision of feedback; 3) training into problem solving and decision making; and 4) training in the use of action plans. Apart from this iterative interaction process, the self-management programme should include at least one of the following components: 1) smoking cessation; 2) self-recognition and/or self-treatment of COPD exacerbations; 3) an exercise or physical activity component; 4) training to cope better with breathlessness; 5) decision making about additional treatment or professional attention; and/or 6) optimising nutrition and/or medication. 2 A COPD self-management programme is a term applied to a structured, patient-tailored, multifaceted programme in which ongoing support is provided to COPD patients to positively change their health behaviour(s) and to develop skills to better manage their COPD and take more ownership of their own health. This support requires ongoing interaction between the patient and a trained healthcare provider that includes: 1) identifying patient's motivations and needs; 2) eliciting formulation of mutual personalised goals; 3) patient training in problem solving and decision making (including the use of action plans and care plans); and 4) provision of feedback by both the healthcare provider and the patient. A COPD self-management programme incorporates behaviour change techniques (including education of appropriate knowledge) aimed at a positive change in behaviour in two of the following groups: 1) preserving or optimising health in “stable” state (e.g. enhancing physical activity, smoking cessation, optimising nutrition, medication, lifestyle, and treatment compliance); 2) self-monitoring of COPD symptoms and initiating appropriate actions when symptoms change (e.g. self-recognition of COPD exacerbations, consulting of healthcare provider(s), self-treatment); 3) assisting the management of the impact of COPD on physical, mental, emotional and social wellbeing (e.g. coping with breathlessness, stress, anxiety, depression and fatigue, energy conservation techniques and engagement in social activities); and 5) improving (assertive) communication with healthcare professionals, family and friends. 3 A COPD self-management intervention is ongoing, structured, personalised and often multifaceted, with goals of motivating, engaging and supporting the patients to positively change their health behaviour(s) and develop skills to manage their disease more effectively. This requires iterative interactions of patients with healthcare professionals who are competent in delivering self-management interventions. Interactions should focus on: 1) identifying motivations, needs and health beliefs; 2) eliciting personalised goals; and 3) formulating appropriate strategies (e.g. self-treatment) to achieve these goals. Behaviour change techniques should be employed to increase motivation to activate and maintain positive COPD management behaviours in order to: 1) optimise and preserve physical health; 2) manage the impacts on mental, emotional, and social wellbeing; and 3) establish effective alliances with healthcare professionals, family and friends. Health literacy disparities should be reduced by using literacy sensitive approaches that enhance comprehensibility. 4 A supported COPD self-management intervention is ongoing, structured but personalised and often multi-component, with goals of motivating, engaging and supporting the patients to positively change their health behaviour(s) and develop skills to better manage their disease. The ultimate goals of supported self-management are: 1) optimising and preserving physical health; 2) reducing symptoms and functional impairments in daily life and increasing emotional well-being, social well-being and quality of life; and 3) establishing effective alliances with healthcare professionals, family, friends and community. The process requires iterative interactions of patients with healthcare professionals who are competent in delivering self-management interventions. The interactions focus on: 1) identifying needs, motivations and health beliefs; 2) eliciting personalised goals; 3) formulating appropriate strategies (e.g. exacerbation management) to achieve these goals; and 4) if required, evaluating and re-adjusting strategies. Behaviour change techniques are used to elicit patient motivation, confidence and competence. Literacy sensitive approaches are used to enhance comprehensibility. 5 (Final) A COPD self-management intervention is structured but personalised and often multi-component, with goals of motivating, engaging and supporting the patients to positively adapt their health behaviour(s) and develop skills to better manage their disease. The ultimate goals of self-management are: a) optimising and preserving physical health; b) reducing symptoms and functional impairments in daily life and increasing emotional well-being, social well-being and quality of life; and c) establishing effective alliances with healthcare professionals, family, friends and community. The process requires iterative interactions between patients and healthcare professionals who are competent in delivering self-management interventions. These patient-centred interactions focus on: 1) identifying needs, health beliefs and enhancing intrinsic motivations; 2) eliciting personalised goals; 3) formulating appropriate strategies (e.g. exacerbation management) to achieve these goals; and if required 4) evaluating and re-adjusting strategies. Behaviour change techniques are used to elicit patient motivation, confidence and competence. Literacy sensitive approaches are used to enhance comprehensibility. COPD: chronic obstructive pulmonary disease.
- TABLE 3
Results from the five consensus rounds#
Round Responses Score¶ Responses with a score of 5¶ 1 (Initial) 21 (78) 3.8±0.87 3 (14) 2 14 (52) 4.2±0.58 4 (29) 3 13 (48) 4.5±0.52 6 (46) 4 21 (78) 4.6±0.50 13 (62) 5 (Final) 23 (85) 4.8±0.39 19 (83) Data are presented as n (%) or mean±sd. #: maximum possible number of responses is 27 because one expert member did not contribute to these scores ratings; ¶: five-point Likert scale: 1=totally disagree, 2=rather disagree, 3=neither, 4=rather agree, 5=totally agree.
- TABLE 4
Broad summary of feedback from rounds 1 to 4
Discussion feedback round 1 Exact wording, terminology must be instantly understandable, addition of further explanations in parentheses “Mandatory” components of a self-management intervention, grouping and re-organising of these components, and rationale why Difference between self-management versus self-management support/intervention/programme Discussion feedback round 2 Shortening of definition Role of motivation Distinction between ultimate treatment goals and the interventions by which we achieve these goals Discussion feedback round 3 Goal of behaviour change is to facilitate confidence and competence as well as motivation Should “ongoing” be included and statement for the need for an adequate assessment? Addition of “evaluations of strategies” Does definition need to be modified so it can be used by commissioners to purchase services? Difference with self-care Supported self-management versus self-management Discussion feedback round 4 Removal of term “ongoing” and question whether behaviour should be “permanently” changed/adapted Inclusion of patient centred Supported self-management versus self-management
Disclosures
Vol 48 Issue 1
Table of Contents
Definition of a COPD self-management intervention: International Expert Group consensus
