Cognitive screening in chronic obstructive pulmonary disease: patient's perspectives

Purpose: Cognitive impairment is highly prevalent (61%) in chronic obstructive pulmonary disease (COPD). International guidelines recommend providing self-management education through resource-intensive, pulmonary rehabilitation programs, yet screening for deficits likely to interfere with learning have received insufficient attention. Concerns over cognitive testing as confronting are described by health professionals as a barrier to screening, but with minimal empiric data. This study explored views on cognitive impairment and screening in patients with COPD.Design: Qualitative study, focus groups.Methods: Participants with COPD were recruited from a respiratory service at a regional hospital. Conversations were recorded, transcribed verbatim, and analyzed using thematic analysis.Results: Focus groups were undertaken between February and May 2014. Fifteen patients, with a diagnosis of COPD and mean age of 73, participated. Thematic analysis resulted in four overall themes: (1) limited awareness of the connection between cognitive change and COPD; (2) cognitive change as part of normal ageing; (3) current strategies for self-management activities and cognition functioning; and (4) attitudes to cognitive testing.Conclusions: This study identified that participants were open to discussing issues of cognitive function suggesting that normalizing discussion around cognitive change presents an opportunity to introduce screening within routine assessments. Identifying cognitive impairment provides opportunity to tailor rehabilitation for those at risk of sub-optimal self-management.Implications for RehabilitationChanges in cognition are recognized as a barrier to optimal self-management and rehabilitation efficacy in chronic disease.This study identified that participants were open to discussing issues of cognitive function suggesting that normalizing discussion around cognitive change presents an opportunity to introduce screening within routine assessments.Identifying cognitive impairment provides opportunity to tailor rehabilitation for those at risk of sub-optimal self-management.