Exploring the interactional sphere of a systemic self-management intervention for chronic obstructive pulmonary disease (COPD)

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Published: May 12, 2014
DOI: https://doi.org/10.5750/ijpcm.v3i4.438
Keywords:
self-management systemic intervention copd discourse analysis qualitative communication

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Ingeborg Farver-Vestergaard
Aarhus University
Frances Early
Cambridge University Hospitals NHS Foundation Trust
Jonathan Fuld
Cambridge University Hospitals NHS Foundation Trust
Christina Gundgaard Pedersen
Aarhus University

Abstract

Patients with chronic obstructive pulmonary disease (COPD) face challenges in managing the physical and psychological consequences of the condition. Systemic self-management interventions based on the Wagner chronic care model seek to facilitate change in patient, healthcare professional (HCP) and healthcare system in order to support patients to self-manage their condition. Few studies have investigated the interactional sphere between patients and HCPs in the context of a systemic self-management intervention. The aim of the present study was to evaluate such an intervention and explore the discursive implications for self-management in COPD. Data were collected via interviews with patients and HCPs, observations of patient-provider interaction and document analysis of documents given to the patients to support self-management. An illustrative analytical model was developed on the basis of Willig’s discourse analysis guidelines. The findings suggested two different ways of talking about self-management – biomedical and patient-centred – that seemed to have implications for what speakers drawing on these discursive repertoires could say, do and experience in relation to self-management support and practice. Whilst the analytical method does not pass judgement on which discourse is ‘best’, results of this study show how the two identified discourses are oriented to different actions and positions, and highlight their relative strengths and limitations. The findings of the present study are relevant to the issue of how the ‘healthcare institution’, and evidence-based medicine as we know it, should be manifested – empirically and practically – in the future.

Article Details

Issue
Vol. 3 No. 4 (2013)
Section
Regular Articles

References

Rabe, K.F., Hurd, S., Anzueto, A. et al. (2007). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. American Journal of Respiratory and Critical Care Medicine 176:532–555.

Wallace, L.M., Turner, A., Kosmala-Anderson, J. et al. (2012). Co-creating health: Evaluation of the first phase. Available at: http://www.health.org.uk/publications/co-creating-health-evaluation-phase-1/ (last accessed 27 February 2014)

Bourbeau, J., Nault, D. (2007). Self-management strategies in chronic obstructive pulmonary disease. Clinics in Chest Medicine 28:617–628.

Bourbeau, J., Julien, M., Maltais, F. et al. (2003). Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: A disease-specific self-management intervention. Archives of Internal Medicine 163:585–591.

Bourbeau, J., Collet, J.-P., Schwartzman, K., Ducruet, T., Nault, D., Bradley, C. (2006). Economic benefits of self-management education in COPD. Chest 130:1704–1711.

Gadoury, M.-A., Schwartzman, K., Rouleau, M. et al. (2005). Self-management reduces both short- and long-term hospitalisation in COPD. The European Respiratory Journal 26:853–857.

Labrecque, M., Rabhi, K., Laurin, C. et al. (2011). Can a self-management education program for patients with chronic obstructive pulmonary disease improve quality of life? Canadian Respiratory Journal 18:e77–81.

Moullec, G., Lavoie, K.L., Rabhi, K., Julien, M., Favreau, H., Labrecque, M. (2012). Effect of an integrated care programme on re-hospitalization of patients with chronic obstructive pulmonary disease. Respirology 17:707–714.

Taylor, S.J.C., Sohanpal, R., Bremner, S.A. et al. (2012). Self-management support for moderate-to-severe chronic obstructive pulmonary disease: A pilot randomised controlled trial. British Journal of General Practice 62:e687–e695.

Effing, T., Monninkhof, E., van der Valk, P. et al. (2007). Self-management education for patients with chronic obstructive pulmonary disease. Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002990.pub2/pdf/standard (last accessed 27 February 2014)

Bucknall, C.E., Miller, G., Lloyd, S.M. et al. (2012). Glasgow supported self-management trial (GSuST) for patients with moderate to severe COPD: randomised controlled trial. BMJ 344:e1060–e1060.

Moullec, G., Favreau, H., Lavoie, K.L., Labrecque, M. (2012). Does a Self-management Education Program Have the Same Impact on Emotional and Functional Dimensions of HRQoL? COPD 9:36–45.

de Silva, D. (2011) Helping people help themselves: A review of the evidence considering whether it is worthwhile to support self-management. Available at: http://www.health.org.uk/publications/?keywords=helping+people+help+themselves&refData_44=&refData_53=&searchSubmit=Go&siid=60. (last accessed 27 February 2014)

Toms, J., Harrison, K. (2002). Living with chronic lung disease and the effect of pulmonary rehabilitation. Physiotherapy 88:605–619.

Wagg, K. (2012). Unravelling self-management for COPD: What next? Chronic Respiratory Disease 9:5–7.

Nault, D., Sedeño, M. (2006). Reference guide for patient education: Educating COPD patients using the self-management program “Living well with COPD.”. Available at: http://www.livingwellwithcopd.com/11-educator-guide-reference-guide-for-patient-education.html (last accessed 27 February 2014)

Giacomini, M., Dejean, D., Simeonov, D., Smith, A. (2012). Experiences of living and dying with COPD: A systematic review and synthesis of the qualitative empirical literature. Ontario Health Technology Assessment Series 12:1–47.

Oliver, S.M. (2001). Living with failing lungs: The doctor-patient relationship. Family Practice 18:430–439.

Sohanpal, R., Seale, C., Taylor, S.J.C. (2012). Learning to manage COPD: A qualitative study of reasons for attending and not attending a COPD-specific self-management programme. Chronic Respiratory Disease 9:163–174.

Wagner, E.H., Austin, B.T., Davis, C., Hindmarsh, M., Schaefer, J., Bonomi, A. (2001). Improving chronic illness care: Translating evidence into Action. Health Affairs 20:64–78.

Wagner, E.H., Austin, B.T., Von Korff, M. (1996). Organizing care for patients with chronic illness. The Milbank Quarterly 74:511–544.

Willig, C. (2008). Introducing qualitative research in psychology.

Berkshire: Open University Press.

Groenewald, T. (2008). Memos and memoing. In: The SAGE encyclopedia of qualitative research methods (ed. L.M. Given), p. 505–516. Los Angeles: SAGE Publications.

Lincoln, Y.S., Guba, E.A. (1985). Naturalistic inquiry. Beverly Hills, CA: SAGE Publications.

Silverman, D. (2011). Interpreting qualitative data: A guide to the principles of qualitative research. London: SAGE Publications Ltd.

Jorgensen, M., Phillips, L. (2002). Discourse analysis as theory and method. London: SAGE Publications.

Foucault, M. (1973). The birth of the clinic. London: Routledge.

Bodenheimer, T., MacGregor, K., Sharifi, C. (2005). Helping patients manage their chronic conditions. Available at: http://www.ndep.nih.gov/resources/diabetes-healthsense/research.aspx. (last accessed 27 February 2014)

Clark, N.M., Gong, M. (2000). Management of chronic disease by practitioners and patients: are we teaching the wrong things? BMJ 320:572–575.

Bourbeau, J. (2008). Clinical Decision Processes and Patient Engagement in Self-Management. Disease Management & Health Outcomes 16:327–333.

von Korff, M., Gruman, J., Schaefer, J., Curry, S.J., Wagner, E.H. (1997) Collaborative management of chronic illness. Annals of Internal Medicine 127:1097–1102.

Wagner, E.H., Bennett, S.M., Austin, B.T., Greene, S.M., Schaefer, J.K., von Korff, M. (2005). Finding common ground: Patient-centeredness and evidence-based chronic illness care. Journal of Alternative and Complementary Medicine 11 Suppl 1:S7–15.

Rogers, A., Kennedy, A., Nelson, E., Robinson, A. (2005). Uncovering the limits of patient-centeredness: Implementing a self-management trial for chronic illness. Qualitative Health Research 15:224–239.

Jones, A., Pill, R., Adams, S. (2000). Qualitative study of views of health professionals and patients on guided self management plans for asthma. BMJ 321:1507–1510.

Kennedy, A.P., Rogers, A.E. (2002). Improving patient involvement in chronic disease management: The views of patients, GPs and specialists on a guidebook for ulcerative colitis. Patient Education and Counseling 47:257–263.

Bensing, J. (2000). Bridging the gap: The separate worlds of evidence-based medicine and patient-centered medicine. Patient Education and Counseling 39:17–25.

Wagner, E.H. (1998). Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice 1:2–4.

Mead, N., Bower, P. (2000). Patient-centredness: A conceptual framework and review of the empirical literature. Social Science & Medicine 51:1087–1110.

Kennedy, A., Rogers, A. (2001). Improving self-management skills: A whole systems approach. British Journal of Nursing 10:734–737.

Beck, A., Scott, J., Williams, P. et al. (1997). A randomized trial of group outpatient visits for chronically ill older HMO members: The Cooperative Health Care Clinic. Journal of the American Geriatrics Society 45:543–549.

Scott, J.C., Conner, D.A., Venohr, I. et al. (2004). Effectiveness of a group outpatient visit model for chronically ill older health maintenance organization members: A 2-year randomized trial of the cooperative health care clinic. Journal of the American Geriatrics Society 52:1463–1470.

Katon, W., von Korff, M., Lin, E., Simon, G. (2001). Rethinking practitioner roles in chronic illness: The specialist, primary care physician, and the practice nurse. General Hospital Psychiatry 23:138–144.

Wagner, E.H. (2000). The role of patient care teams in chronic disease management. BMJ 320:569–572.

Wasson, J.H., Jette, A.M., Johnson, D.J., Mohr, J.J., Nelson, E.C. (1997). A replicable and customizable approach to improve ambulatory care and research. The Journal of Ambulatory Care Management 20:17–27.

Fan, V.S., Gaziano, J.M., Lew, R. et al. (2012). A comprehensive care management program to prevent chronic obstructive pulmonary disease hospitalizations: A randomized, controlled trial. Annals of Internal Medicine 156:673–683.

Entwistle, V.A., Cribb, A. (2013). Enabling people to live well: Fresh thinking about collaborative approaches to care for people with long-term conditions. Available at: http://www.health.org.uk/publications/?keywords=enabling+people+to+live+well&refData_44=&refData_53=&searchSubmit=Go&siid=60. (last accessed 27 February 2014)

Meyer, J.M., Ginsburg, G.S. (2002). The path to personalized medicine. Current Opinion in Chemical Biology 6:434–438.

Doz, F., Marvanne, P., Fagot-Largeault, A. (2013). The person in personalised medicine. European Journal of Cancer 49:1159–1160.

Harvey, A., Brand, A., Holgate, S.T. et al. (2012). The future of technologies for personalised medicine. New Biotechnology 29:625–633.

Long, A.F., Mercer, G., Hughes, K. (2000). Developing a tool to measure holistic practice: A missing dimension in outcomes measurement within complementary therapies. Complementary Therapies in Medicine 8:26–31.

Long, A.F. (1997). Key issues in outcomes measurement. International Journal of STD & AIDS 8:663–667.

Oliver, S. (1997). Exploring lay perceptions on questions of effectiveness. In: Non-random reflections on health service research. (eds. A. Maynard, I, Chalmers), pp. 272-291. London: BMJ Publishing Group.

Rogers, R., Malancharuvil-Berkes, E., Mosley, M., Hui, D., Joseph, G.O. (2005). Critical discourse analysis in education: A review of the literature. Review of Educational Research 75:365–416.

Starks, H., Trinidad, S.B. (2007). Choose your method: A comparison of phenomenology, discourse analysis, and grounded theory. Qualitative Health Research 17:1372–1380.

Willig, C. (2000). A discourse-dynamic approach to the study of subjectivity in health psychology. Theory & Psychology 10:547–570.

Willig, C. (1995). “I wouldn”t have married the guy if i’d have to do that': Heterosexual adults' constructions of condom use and their implications for sexual practice. Journal of Community & Applied Social Psychology 5:75–87.

Gillies, V., Willig, C. (1997). `You get the nicotine and that in your blood’: Constructions of addiction and control in women's accounts of cigarette smoking. Journal of Community & Applied Social Psychology 7:285–301.

Parker, I. (1994). Reflexive research and the grounding of analysis: Social psychology and the psy-complex. Journal of Community & Applied Social Psychology 4:239–252.

Hoddinott, P., Pill, R. (1997). A review of recently published qualitative research in general practice. More methodological questions than answers? Family Practice 14:313–319.

Krefting, L. (1991). Rigor in qualitative research: The assessment of trustworthiness. The American Journal of Occupational Therapy 45:214–222.