Applying a cognitive behavioural approach in COPD: views of respiratory professionals

Rationale
Chronic obstructive pulmonary disease (COPD) is a long-term condition with comorbidities such as anxiety and depression that are associated with poorer health outcomes. The TANDEM (Tailored psychological intervention for anxiety or depression in COPD) trial investigated whether delivery of a psychological intervention by respiratory healthcare professionals (“Facilitators”) using a tailored cognitive behavioural approach (CBA) to patients with advanced COPD would reduce anxiety and/or depression and improve pulmonary rehabilitation (PR) attendance. The intervention did not reduce anxiety or depression or improve PR attendance. As part of the trial process evaluation, we explored Facilitators’ communication with patients, professional role and identity, and perspectives on implementation.

Methods
Qualitative interviews with 14 Facilitators (nurses, physiotherapists, occupational therapists) who were trained to deliver the CBA sessions.

Results
Facilitators recognised the need for psychological care, and were positive about the training, practice, and clinical supervision. The intervention was viewed as helpful for some, but not all, patients. Comorbidities and social and personal challenges affected patient engagement in identifying and addressing COPD-related anxiety and depression. There was scepticism about the incorporation of a CBA intervention such as TANDEM into routine healthcare due to resource constraints.

Conclusions
Respiratory healthcare professionals valued being trained and supported to deliver a tailored CBA intervention to patients with COPD. The complexity of comorbidity and patients’ social context presented barriers to engagement. The intervention was viewed as unlikely to be delivered as part of routine care. Greater focus on patient engagement in the context of multimorbidity and psychosocial complexity is recommended.