Empowerment in people with COPD

Rebecca T Disler,1–3 Jessica Appleton,1 Tracy A Smith,4,5 Matthew Hodson,6 Sally C Inglis,1,2 DorAnne Donesky,7 Patricia M Davidson8 1Faculty of Health, University of Technology Sydney, 2Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, 3Improving Palliative Care through Clinical Trials (ImPACCT), Sydney, 4Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, 5Faculty of Medicine, University of NSW, Sydney, NSW, Australia; 6ACERS, Integrated Medicine and Rehabilitation Services Division, Homerton University Hospital NHS Foundation Trust, London, UK; 7Department of Physiological Nursing, UCSF School of Nursing, San Francisco, CA, 8School of Nursing, Johns Hopkins University, Baltimore, MD, USA Background: Patient empowerment is recognized as an important aspect of chronic disease management. There is an increasing expectation that health providers engage patients as active participants in their own self-management. This engagement is crucial to the chronic care model as patients with COPD and their families manage the majority of the care in the community. Understanding what influences empowerment will help health care professionals to better engage in collaborative care planning and decision making that meet the needs of this new generation of health consumers. Aim: The aim of the present study was to identify interventions or approaches that empower patients in the management of COPD. Methods: An integrative review was undertaken following the preferred reporting items for systematic reviews and meta-analyses approach. Papers were included if they 1) provided a definition or conceptualization of empowerment, and 2) reported interventions or approaches fostering empowerment in patients with COPD. Thematic analysis was used to develop conceptual themes on patient empowerment in COPD. These conceptual themes were validated by a panel of specialists in COPD, chronic disease management, self-management, and patient education. Results: Literature searching revealed 183 papers of which 15 studies conceptualized or defined empowerment interventions or approaches to support COPD management. These were grouped into the following five categories: pulmonary rehabilitation, social support, web-based interventions, approaches that support knowledge development, and the approach taken by the health care professional. Conclusion: Pulmonary rehabilitation, knowledge acquisition, social support, telehealth and web-based interfaces, and collaboration with health care professionals empower patients to recognize their own strengths and to manage the impact of the condition. Patients' abilities to direct their own care are additionally influenced by physical debilitation, treatment complexity, economic status, and health literacy. Health care professional–patient relationships must shift to a more collaborative approach that recognizes the patient as an expert in their own condition and facilitates patients to determine their own plan of care and life goals. Keywords: COPD, chronic disease, empowerment, peer support, telehealth care, self-efficacy, active participatio