Article

PURPOSE: To explore how patients who refuse referral to pulmonary rehabilitation
(PR) appraise acute exacerbations of chronic obstructive pulmonary disease
(COPD), in the context of having considered and declined PR. METHOD: Six participants recently hospitalized with an acute exacerbation COPD who refused a
referral to PR subsequent to hospital discharge participated in in-depth
interviews. Transcripts were subjected to interpretative phenomenological
analysis (IPA). RESULTS:
Three conceptual themes emerged comprising:
"Construction of the self", reflecting the impact of the acute exacerbation on
personal identity; "Relinquishing control", describing participants" struggle to
maintain agency following an acute event; and "Engagement with others", embodying
participants' sensitivity and responsiveness to interactions with others.
CONCLUSIONS: Prominent in theses participants' narratives are self-conscious
cognitions which appear founded in shame and stigmatization. These cognitions
seem to reflect challenges to self-worth and appear associated with reduced
help-seeking and isolation. Perceived personal culpability for COPD appears to
sensitize participants' towards their interactions with health care
professionals, construed as critical and judgmental which may increase avoidant
behaviors, such as refusal of PR. When introducing PR, professionals should be
aware of such sensitivities and facilitate open discussion which offers, time,
compassion and understanding as a means of facilitating uptake. IMPLICATIONS FOR
REHABILITATION: Patients who decline referral to pulmonary rehabilitation report
self-conscious cognitions (i.e., shame, guilt, fear of others evaluation)
associated with lowered self-worth and reduced help-seeking. When introducing
pulmonary rehabilitation health care professionals need to be mindful of
patients' sensitivities to being shamed which stem from perceived culpability for
COPD. Professionals should facilitate an open discussion with patients which
offers, time, compassion and understanding as a means of facilitating pulmonary
rehabilitation uptake. Compassion focused interventions which encourage trust and
safety may promote active partnership working and facilitate engagement in
pulmonary rehabilitation.

Langue : ANGLAIS