TANDEM (Tailored intervention for ANxiety and DEpression Management in COPD) trial: Qualitative interviews with health care professionals from the pilot phase

Problem

Many people with chronic obstructive pulmonary disease (COPD) are affected by anxiety and/or depression. Both anxiety and depression are associated with an increased likelihood of exacerbations, more frequent and longer hospital admissions, and reduced survival. Cognitive behavioural therapy is an evidence-based treatment which explores the links between thoughts, feelings, physical symptoms and behaviour. The TANDEM trial was designed to assess if a tailored cognitive behavioural approach (CBA) intervention may improve anxiety and depression in COPD patients prior to pulmonary rehabilitation. Here, we report on acceptability of the intervention and experience of involvement in the pilot phase from the perspective of health care professionals (HCPs) trained in CBA as part of TANDEM.

Approach

HCPs were trained to deliver the CBA intervention, to address mild/moderate anxiety and/or depression in people with moderate/very severe COPD. All HCPs in the pilot were interviewed. The interviews explored their motivations to take part in TANDEM, their experience of the training and supervision, and the intervention delivery with particular focus on acceptability and feasibility. Thematic analysis of the interview transcripts was carried out by a multidisciplinary research team. A coding frame was constructed and systematically applied to the data. Identification and analysis of themes involved the constant comparison method. Team discussions were held to interpret the data and to maximize validity and reliability.

Findings

HCP’s background professions were: 2 physiotherapists, 2 respiratory nurses, and 1 health psychologist. The HCPs perceived a need for exploring patient’s self-management barriers and felt the CBA intervention enabled this. They were pleased to be able to add a psychological approach to «traditional » medical management. The CBA training was appreciated and described as ‘very helpful’ and well balanced between theory and practice. Regular supervision sessions from a senior clinical psychologist were found to be a valuable aspect of the TANDEM training. Overall, most of the HCPs felt that the TANDEM intervention was positive but raised some issues related to the patients who were dealing with multi-morbid medical conditions (including hospitalisations interrupting CBA sessions), complex needs, beliefs, and feelings (especially guilt) and adapting to a new care approach. Issues raised from the HCP’s perspective included: time limitations, requirement to be accepted by the patient, initial lack of confidence in their competence to deal with depression and/or anxiety issues, and difficulty adjusting to a ‘psychological’ role compared to their ‘biomedical’ role.

Consequences

All the HCPs felt that the TANDEM intervention will be beneficial for some patients. They valued the opportunity to participate in the TANDEM training sessions and the supervision support received when applying CBA in practice.