TANDEM (Tailored intervention for ANxiety and DEpression Management in COPD): Qualitative evaluation from the pilot/feasibility phases

Conference:

SAPC ASM 2018 - London

Talk Code:

P1.24

Presenter:

Ratna Sohanpal

Twitter:

@Ratna_Sohanpal

Co-authors:

Amy Barradell, Kritie-Marie Mammoliti, Anna Moore, Stephanie Taylor, Hilary Pinnock

Author institutions:

University Hospitals of Leicester NHS Trust, Queen Mary University of London, Edinburgh University

Problem

Patients with Chronic Obstructive Pulmonary Disease (COPD) commonly experience depression and anxiety and both functional limitations and psychological problems can negatively influence health outcomes. Completion of pulmonary rehabilitation (PR) programme improves anxiety and depression as well as exercise tolerance however, there is under-referral, poor attendance and completion of the programme. TANDEM is a randomised controlled trial (RCT) assessing whether a cognitive behavioural approach (CBA) intervention, delivered prior to PR can help to improve mild to moderate anxiety and/or depression in those with moderate to very severe COPD and encourage PR uptake/completion. We report acceptability of the intervention, experience of involvement in the pilot, and trial feasibility from the participants’ perspective.

Approach

Individual face-to-face interviews were conducted with trial participants (Intervention n=4; Control, n=3) following completion of intervention delivery. Reasons and experience of participating in the study, experience of receiving the intervention and suggestions for improvement were explored. Interviews were recorded, transcribed verbatim and analysed thematically.

Findings

The TANDEM trial was well received by the study participants. Participants perceived the CBA intervention as mitigating the substantial burden of COPD and anxiety/depression, providing self-management skills and tools, which in turn increased confidence and ability to manage their conditions. Five emergent themes were identified. (1) Negative impact of COPD and anxiety/depression “… It's such a mess in the head because this has got to be done, that's got to be done, that's got to be… and then you do nothing” (2) Willingness to be involved in TANDEM “Really and truthful I think you ought to with this complaint, try everything.” (3) Acceptability of the recruitment process “…there was so much paperwork. But there again, very necessary to get the answers otherwise you don't know anything about me, do you?” (4) Acceptability of the intervention including PR “[Intervention] makes you aware of what you can do to help yourself.” (5) Refinements in the recruitment process and intervention for the main trial. “I think in a sense it's not what you've got to improve but what we've got to improve. In fact, maybe a phone call in between to say have you done that what I've asked you? Because we tend to leave it and leave it and leave it. And you need to be prodded.”

Consequences

The findings will be used to make refinements to the recruitment process and the intervention, prior to evaluation in the fully powered TANDEM multi-centre trial which will commence in Spring 2018.

Submitted by:

Ratna Sohanpal

Funding acknowledgement:

We would like to thank the study participants. This project was funded by the National Institute for Health Research Health Technology Assessment programme (project number 13/146/02). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Health Technology Assessment programme, NIHR, NHS or the Department of Health.