Insights from Australians with respiratory disease living in the community with experience of self-managing through an emergency department 'near miss' for breathlessness: A strengths-based qualitative study

Luckett, Tim; Phillips, Jane; Johnson, Miriam; Garcia, Maja; Bhattarai, Priyanka; Carrieri-Kohlman, Virginia; Hutchinson, Anne; Disler, Rebecca T.; Currow, David; Agar, Meera; Ivynian, Serra; Chye, Richard; Newton, Phillip J.; Davidson, Patricia M.

Abstract

Objectives Breathlessness ‘crises’ in people with chronic respiratory conditions are a common precipitant for emergency department (ED) presentations, many of which might be avoided through improved self-management and support. This study sought insights from people with experience of ED ‘near misses’ where they considered going to the ED but successfully self-managed instead. Design and methods A qualitative approach was used with a phenomenological orientation. Participants were eligible if they reported breathlessness on most days from a diagnosed respiratory condition and experience of ≥1 ED near miss. Recruitment was through respiratory support groups and pulmonary rehabilitation clinics. Semi-structured interviews were conducted with each participant via telephone or face-to-face. Questions focused on ED-related decision-making, information finding, breathlessness management and support. Analysis used an integrative approach and independent coding by two researchers. Lazarus’ and Cohen’s Transactional Model of Stress and Coping informed interpretive themes. Results Interviews were conducted with 20 participants, 15 of whom had chronic obstructive pulmonary disease. Nineteen interviews were conducted via telephone. Analysis identified important factors in avoiding ED presentation to include perceived control over breathlessness, self-efficacy in coping with a crisis, and desire not to be hospitalised. Effective coping strategies included: taking a project management approach that involved goal setting, monitoring, and risk management; managing the affective dimension of breathlessness separately from the sensory-perceptual; and building three-way partnerships with primary care and respiratory services. Conclusions As well as teaching non-pharmacological and pharmacological management of breathlessness, interventions should aim to develop patients’ generic self-management skills. Interventions to improve self-efficacy should ensure this is substantiated by transfer of skills and support, including knowledge about when ED presentation is necessary. Complementary initiatives are needed to improve coordinated, person-centred care. Future research should seek ways to break the cyclical relationship between affective and sensory-perceptual dimensions of breathlessness.

Citation

Luckett, T., Phillips, J., Johnson, M., Garcia, M., Bhattarai, P., Carrieri-Kohlman, V., …Davidson, P. M. (2017). Insights from Australians with respiratory disease living in the community with experience of self-managing through an emergency department 'near miss' for breathlessness: A strengths-based qualitative study. BMJ open, 7(12), e017536. https://doi.org/10.1136/bmjopen-2017-017536

• Journal Article Type: Article
• Acceptance Date: Oct 26, 2017
• Online Publication Date: Dec 6, 2017
• Publication Date: Dec 1, 2017
• Deposit Date: Oct 31, 2017
• Publicly Available Date: Dec 8, 2017
• Journal: BMJ Open
• Print ISSN: 2044-6055
• Electronic ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 7
• Issue: 12
• Article Number: e017536
• Pages: e017536
• DOI: https://doi.org/10.1136/bmjopen-2017-017536
• Keywords: Adult thoracic medicine; Qualitative research; Primary care
• Public URL: https://hull-repository.worktribe.com/output/456096
• Publisher URL: https://bmjopen.bmj.com/content/7/12/e017536