Assessment of self-management needs among patients with COPD

Introduction: While self-management is an essential part of chronic illness care, little is known about patients9 perspectives of their self-management needs. Objective: To address this gap we conducted a cross-sectional, self-management needs assessment among patients with COPD. Methods: Patients were enrolled from clinics as part of a self-management intervention trial. Patient activation was categorized based on thier confidence in self-management and on motivation to participate in their care. Behavioral intentions addressed readiness to quit smoking and to meet physical activity goals. Self-efficacy was assessed using a COPD-specific scale. Open-ended questions assessed self-care facilitators, barriers, and goals. Results: Of 76 patients enrolled, mean age was 69.2 years with 49.1% female. For patient activation 29.0% are active, 31.6% high effort, 23.7% complacent, and 15.8% passive. Among current smokers the majority are interested in quitting with 35% contemplation, 30% preparation, and 20% action. While mean levels of reported self-efficacy were similar across domains, the proportion reporting low levels of confidence were greatest for physical activity and behavioral domains (56.6%). In a qualitative analysis of 34 interviews major themes relevant to self-management facilitators, barriers, and goals were fear (i.e., disease progression, suffocation/death), loss (i.e., functioning, independence, cherished activities), co-morbid limitations, stigma/social isolation, and desire for change (i.e., improve functioning, better care, information, understanding). Conclusions: The results from this cross-sectional analysis highlight the complexity of self-management support needs among patients with COPD.