Health care professionals’ experiences of using a cognitive behavioural approach with patients living with chronic obstructive pulmonary disease

Problem

There is an increased risk of psychological co-morbidities for people with chronic obstructive pulmonary disease (COPD), which often go unnoticed and untreated. The TANDEM trial developed a tailored, cognitive behavioural approach (CBA) intervention for patients with COPD and anxiety and/or depression. The aims were to improve mood in patients with anxiety and/or depression and increase uptake of pulmonary rehabilitation (PR). Respiratory healthcare professionals (facilitators) were recruited and received tailored training in CBA. Supported by telephone supervision from a clinical psychologist, the facilitators saw trial patients for six to eight sessions, usually in the patient’s home.

Approach

ObjectivesTo explore • The experiences of health care professionals working as CBA facilitators with patients living with COPD. • The facilitators’ views regarding the implementation of the TANDEM model in usual care.MethodsAs part of the process evaluation, qualitative interviews were conducted via telephone with facilitators who consented to participate. Interviews, conducted by two researchers, addressed the core objectives. Sampling was purposive, aiming to achieve a maximum variation sample. Thematic analysis (assisted by NVivo) was iterative using a small team approach, to aid interpretation.

Findings

Interviews were conducted with ten facilitators, including three nurses, three occupational therapists and four physiotherapists. Facilitators considered the CBA skills they had learnt enabled them to improve the quality of care they provide patients. Using CBA opened up a broader view of patients’ lives and facilitatorsto ‘show more empathy to these patients’ and appreciate that some patients were often dealing with co-morbities. Facilitators were ‘struck at how complicated everyone’s lives are’ with concerns other than their COPD which could be overlooked in a time-limited clinical setting. Though the time to be able to commit to these participants with complex lives was valued, facilitators also mentioned that it wasn’t always easy to manage. Most facilitators said that they found it difficult to adapt from their problem-solving approach to the patient-centred CBA, describing the training as having ‘massively changed my approach with patients’. Facilitators gave examples of how they would use the CBA skills in their professional roles outside of TANDEM ‘because it would make us all better at actually supporting our patients’. Supervision from a clinical psychologist was new to all facilitators and valued. Most facilitators believed that a major obstacle for implementing the TANDEM intervention in usual care would be time and that this time is focusing on a holistic approach rather than simply addressing the physical symptom(s).

Consequences

The CBA training was valued by facilitators in the context of the TANDEM trial, and also for the transferable skills that could be applied in their routine work. The patient-centred approach was time-consuming but considered worthwhile, albeit raising concerns about implementation in a time-limited NHS.