3 ways patient beliefs impact treatment
Research shows that the clinical outcomes of chronic respiratory diseases such as COPD can be adversely affected by the impact of the disease on psychosocial factors and quality of life.1
By addressing patient perception, self-blame and treatment expectations, GPs have the potential to improve respiratory symptoms and the functional capacity of patients – as well as their overall well-being.
Respiratory research provides several factors affecting patient outcomes, and offers some tips for daily practice.
1. Self-blame delays treatment and affects compliance
Along with lung cancer patients, people with COPD may feel the disease is their fault and they are being judged by others because their disease can be attributed to smoking, the main modifiable risk factor for COPD.1
Low self-esteem and self-blame about having a “self-inflicted” disease prevent people from seeking help, even when they are experiencing symptoms, and some COPD patients report feeling unworthy of receiving treatment.1,2
Respiratory diseases including COPD have been linked to anxiety, depression, and feelings of helplessness about the inability to prevent breathlessness and impairment of daily activities and lifestyle.2
Australian data show that, in 2014–15, 22% of COPD patients aged 45 years and over rated their health as “poor”, compared to 6% of those without it. And while 50% of people without COPD rated their health as very good or excellent, only 25% of those with COPD said the same.3
Stigma and shame have been linked to:
- delays in seeking medical help1
- patients hiding their diagnosis of COPD from friends and family1
- more severe symptoms than would otherwise be expected1
- poor use of treatments1
- poor treatment compliance.1
2. Lack of understanding causes needless suffering
Research has shown that there remains significant misunderstanding about COPD, not only in people unaffected by COPD but also in those already diagnosed.2
There is lack of awareness that COPD is a chronic condition, and lack of understanding that a diagnosis of emphysema or chronic bronchitis is actually COPD.2
Some studies found that GPs did not always clearly explain the diagnosis to the patient, possibly because they found it difficult to explain specialist respiratory concepts to the layperson.2
This lack of understanding may result in:
- patients failing to discuss their symptoms with their GP and suffering alone2
- patients missing out on lifestyle and social support that could enhance their quality of life2
- patients missing out on medication that could alleviate symptoms and prevent exacerbations.2
3. Delayed disease acceptance delays therapy benefits
When surveyed, healthcare professionals felt that patients who delayed acceptance of their disease delay lifestyle and treatment changes that could improve well-being.4
Denial about the chances of their symptoms deteriorating, or even being due to COPD at all, can result in a refusal to try to quit smoking, or other measures to improve their condition.2
Some people under- or over-estimate their physical abilities, leading to unrealistic goals for therapy.4
One study found that the process of pulmonary rehabilitation allowed COPD patients to consider what they were capable of, rather than focusing on what they couldn’t do, and this allowed them to finally accept their disease.4
Lung Foundation Australia is encouraging COPD patients to spot the signs of exacerbations with its “Have the Chat” initiative.
Learn more at: http://lungfoundation.com.au/have-the-chat/
References: 1. Rose S et al. Chron Respir Dis 2017; 14 (1): 1–18. 2. Goldman RE et al. Chron Respir Dis 2017; 14(3): 245–55. 3. Australian Institute of Health and Welfare 2016. How does COPD affect quality of life? Available online: http://www.aihw.gov.au/copd/quality-of-life/ Accessed 10/8/17. 4. Meis J et al. Respir Med 2014; 108: 500–10. 5. Murphy L et al. Chron Respir Dis 2017; 14(3): 276–88.
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