How can healthcare professionals promote pulmonary rehabilitation in people with COPD? A qualitative study

Despite the evidence for pulmonary rehabilitation programs (PRPs) in people with chronic obstructive pulmonary disease (COPD), uptake of this intervention is suboptimal. Our group recently noted novel barriers to the uptake of PRPs in people with COPD, such as feeling unworthy of healthcare. Little is known about factors that contribute to this feeling. We explored autobiographical experiences of the interaction between HCPs and people with COPD at the time a PRP was recommended as an appropriate intervention.

This qualitative study was guided by a critical realist perspective. Both HCPs and people with COPD were recruited from tertiary hospitals. Questions were based on the theoretical domains framework and explored the determinants of behaviour related to initiating a referral to a PRP and the person with COPD enrolling in a program. Interview transcripts were analysed using reflexive thematic analysis.

Data were available on 15 participants with COPD and 38 HCPs. The first theme was that the HCP needed to care for the person and not just treat a disease. Subthemes pertained to language and behaviours of the HCP including, (i) actively listening, (ii) demonstrating genuine empathy, (iii) establishing trust and, (iv) empowering the person with COPD to engage in shared decision-making. The second theme was that the HCP needed to instil hope that pulmonary rehabilitation would benefit the person with COPD. Subthemes comprised; (i) enthusiasm of the referrer and sharing their vicarious experiences that PRPs have helped others, (ii) describing the intervention, allaying fears and personalising a positive outcome following program completion, (iii) having a physician endorse the PRP, (iv) using terms other than 'pulmonary rehabilitation'.

These data provide a blueprint for interactions in which HCPs can foster people with COPD to accept a referral to a PRP, in a manner that translates to enrolment in a program.