COPD Action Plans: Gaps in Development Methods, Content, and Format.

Area of Science:

• Pulmonary Medicine
• Health Services Research
• Patient Education

Background:

• Chronic Obstructive Pulmonary Disease (COPD) action plans (APs) are crucial for self-management but have low primary care provider and patient utilization.
• Uptake of COPD APs is influenced by their content, format, and development processes.

Purpose of the Study:

• To analyze the characteristics of existing COPD action plans (APs) by collecting and examining a broad sample.
• To identify factors contributing to the low usage of COPD APs.

Main Methods:

• Collected 63 English-language COPD APs from diverse international sources, including internet searches, guidelines, organizations, and RCTs.
• Analyzed APs for background information, development methods, evaluation data, content, and format using guideline-based and inductive criteria.
• Assessed readability using Flesch-Kincaid scores and formatting against evidence-based standards.

Main Results:

• Development methods were documented for only 11% of APs, with patient involvement in only one.
• Formal evaluation data was scarce, with only 7% of non-RCT sourced APs evaluated.
• Significant inconsistencies were found in AP content (treatment definitions, instructions, behavioral cues) and variable formatting, with APs meeting an average of 5.4/8 core formatting principles.
• Average Flesch-Kincaid readability score was 6.5, indicating a reading level potentially challenging for some patients.

Conclusions:

• Existing COPD APs have intrinsic factors in their development, evaluation, content, and format that contribute to a significant care gap.
• There is a need to develop and evaluate a standardized COPD AP that incorporates user preferences, expert consensus on content, and optimized usability and format.