Review
Factors influencing self-management in chronic obstructive pulmonary disease: An integrative review☆

https://doi.org/10.1016/j.ijnurstu.2011.11.005Get rights and content

Abstract

Background

Chronic obstructive pulmonary disease is a common, chronic and burdensome condition requiring the individual to engage in a range of self-management strategies. The capacity to engage in self-management is dependent on a range of internal (e.g. personal) and external (e.g. health service) factors.

Objectives

This paper seeks to define self-management, identify the determinants which influence the individual's ability to cope and adjust to living with chronic obstructive pulmonary disease in the community, and identify implications for clinical practice and research.

Data sources

Medline, Embase, PubMed, CINAHL, Google Scholar.

Review methods

Integrative review using prospective research questions. Papers were included in the review if they were published in peer reviewed journals and written in English between 2000 and 2010. Articles were accepted for inclusion if they discussed the determinants that influenced self-management of chronic obstructive pulmonary disease in the community. Confirmation of results and discussion themes was validated by specialists in chronic obstructive pulmonary disease and complex care.

Findings

Self-management is less well characterised in chronic obstructive pulmonary disease compared with other chronic conditions. Functional limitation and the need to balance disease management with everyday life are the two key elements that patients face in managing their condition. Provider characteristics, socioeconomic status and health literacy are sparsely discussed yet are known to influence chronic obstructive pulmonary disease self-management.

Conclusions

Chronic obstructive pulmonary disease self-management must be a key focus internationally as the disease incidence increases. Collaborative care is required between patients and health providers in order facilitate patients in confident management of their condition.

Section snippets

Background

Chronic obstructive pulmonary disease (COPD) is one of the most common and burdensome chronic conditions globally. COPD affects 80 million people worldwide and is the fourth most prevalent cause of death. COPD also accounts for 3.5% of total years lost due to disability (YLD). As populations age in the developed world and smoking rates and the use of bio-fuels rise in emergent economies, such as China, the burden of COPD internationally is set to increase by 30% over the next 20 years (WHO, 2004

Aims

This integrative review sought to facilitate a comprehensive review of the influences on self-management in COPD and to develop a conceptual model to illustrate this.

Design

Using the method of an integrative review this paper sought to explore the influences on self-management in COPD. An integrative approach allows for a broad review of both empirical and theoretical literature in order to comprehensively understand complex concepts, theories or healthcare problems (Whittemore and Knafl, 2005). This

Selected papers

The process of paper selection and exclusion is demonstrated in Fig. 2. Through literature searching 29,070 papers were identified as related to COPD and 46,353 related to self-management. 550 of those papers related to COPD and self-management. 430 papers met the inclusion criteria of being written in the English language and published between the years 2000 and 2010. 162 of these papers were retrieved for detailed examination after review of abstracts and removal of duplications. Of these

Discussion

As outlined self-management is a complex construct and influenced by a range of factors. Understanding the diverse factors contributing to self-management is important in developing tailored and targeted interventions and supporting individuals to self-care. It is also important to consider the individuals interaction with health and social systems and the influence of socioeconomic factors on health status and self-management. The conceptual model developed through this integrative review (

Conclusion

COPD is a progressive and debilitating condition requiring complex self-management behaviours. A diverse range of physical, social, cultural, psychological and existential issues influence the individuals’ capacity to self-manage. Appreciating this complex interplay is critical for supporting individuals and their families in living with COPD.

References (64)

  • H.Q. Nguyen et al.

    Dyspnea self-management in patients with chronic obstructive pulmonary disease, moderating effects of depressed mood

    Psychosomatics

    (2005)
  • A. Niesink et al.

    Systematic review of the effects of chronic disease management on quality-of-life in people with chronic obstructive pulmonary disease

    Respiratory Medicine

    (2007)
  • F. Pasqua et al.

    Use of functional independence measure in rehabilitation of inpatients with respiratory failure

    Respiratory Medicine

    (2009)
  • R.A. Pauwels

    National and international guidelines for COPD, the need for evidence

    Chest

    (2000)
  • Australian Institute of Health and Welfare

    Australia's Health 2008

    (2008)
  • P.H. Bailey

    The dyspnea–anxiety–dyspnea cycle—COPD patients’ stories of breathlessness, it's scary/when you can’t breathe

    Qualitative Health Research

    (2004)
  • M. Barnett

    Caring for a patient with COPD, a reflective account

    Nursing Standard

    (2005)
  • M. Barnett

    Promoting self-management for patients with COPD

    Journal of Community Nursing

    (2009)
  • B.E. Berger et al.

    The Experience of Stigma in Chronic Obstructive Pulmonary Disease

    (2010)
  • T. Bodenheimer et al.

    Patient self-management of chronic disease in primary care

    JAMA

    (2002)
  • R. Booker

    Chronic obstructive pulmonary disease, non-pharmacological approaches

    British Journal of Nursing

    (2005)
  • J. Bourbeau

    Self-management interventions to improve outcomes in patients suffering from COPD

    Expert Review of Pharmacoeconomics & Outcomes Research

    (2004)
  • J. Bourbeau

    Clinical decision processes and patient engagement in self-management

    Disease Management & Health Outcomes

    (2008)
  • J. Bourbeau et al.

    New and controversial therapies for chronic obstructive pulmonary disease

    Proceedings of the American Thoracic Society

    (2009)
  • J. Bourbeau et al.

    Promoting effective self-management programmes to improve COPD

    European Respiratory Journal

    (2009)
  • V. Carrieri-Kohlman et al.

    Desensitization and guided mastery, treatment approaches for the management of dyspnea

    Heart and Lung

    (1993)
  • K.-H. Chen et al.

    Self-management behaviours for patients with chronic obstructive pulmonary disease, a qualitative study

    Journal of Advanced Nursing

    (2008)
  • N.M. Clark et al.

    Focusing on outcomes, making the most of COPD interventions

    International Journal of COPD

    (2009)
  • P.A. Coventry et al.

    Prediction of appropriate timing of palliative care for older adults with non-malignant life-threatening disease: a systematic review

    Age & Ageing

    (2005)
  • J.M. Cranston et al.

    Models of chronic disease management in primary care for patients with mild-to-moderate asthma or COPD, a narrative review

    Medical Journal of Australia

    (2008)
  • R. Deprez et al.

    Improving quality of care for patients with chronic obstructive pulmonary disease

    Population Health Management

    (2009)
  • C.A. Dowson et al.

    Anxiety and self-management behaviour in chronic obstructive pulmonary disease, what has been learned?

    Chronic Respiratory Disease

    (2004)

    • Cited by (108)

    • Long-term services and supports and disease management among older Chinese adults in different stages of cognitive impairment

      2022, Journal of the Economics of Ageing
      Citation Excerpt :

      Second, we provide novel evidence on the impacts of informal and formal LTSS on the performance of disease management. While there is a growing body of studies showing the health impacts of LTSS, such as their impacts on physical function, mental health, harms, and mortality, evidence on disease prevention or chronic disease management is limited, especially in developing contexts (Disler et al., 2012; Sohn et al., 2020; Tan et al., 2019; Wysocki et al., 2015). This study enriches our understanding of the effects of access to LTSS on both preventive care utilization and the management of hypertension among Chinese older adults.

    • Health repercussions of environmental exposure to lead: Methylation perspective

      2021, Toxicology

    • Self-management support (SMS) in primary care practice: a qualitative focus group study of care professionals’ experiences

      2024, BMC Primary Care

    • Exploring the Link between Social Support and Patient-Reported Outcomes in Chronic Obstructive Pulmonary Disease Patients: A Cross-Sectional Study in Primary Care

      2024, Healthcare (Switzerland)

    • Self-efficacy and healthcare costs in patients with chronic heart failure or chronic obstructive pulmonary disease

      2024, ESC Heart Failure

    • Association of TAS2R16 gene (rs860170, rs978739, rs1357949) polymorphisms and TAS2R16 serum levels in patients with age-related macular degeneration

      2024, Ophthalmic Genetics
    View all citing articles on Scopus
    ☆

    This paper was shortlisted for the International Network for Doctoral Research in Nursing (INDEN) Award, sponsored by the International Journal of Nursing Studies. The award is open to current doctoral students and those who have graduated from a doctoral programme within the past 12 months.

    View full text
    Copyright © 2011 Elsevier Ltd. All rights reserved.