ABSTRACT
Introduction/Aim: Studies of the lived experience of Chronic Obstructive Pulmonary Disease (COPD) reveal a number of challenges patients face when interacting with healthcare providers that may be exacerbated by unwillingness or inability to quit smoking. However, none have explored, in-depth, primary care experiences among patients with COPD in community healthcare settings. The study investigated primary care experiences of patients living independently in the community with doctor diagnosed COPD, who smoke or had recently quit smoking and focused on how vulnerability, stigma and emotional components of care shape care experiences. Method(s): An Interpretative Phenomenological Analysis (IPA) involving thirteen participants purposively recruited from social media posts in COPD and carer support groups, general community groups, community noticeboards and paid adverts on social media. In-depth interviews were held between February and April 2022 by phone or Zoom TM and explored healthcare experiences, smoking, stigma and impact of care during COVID-19. Cross-case analysis was conducted to form group experiential themes. Result(s): Participants were aged between 45 to 75 years. Nine were female and two-thirds were current daily smokers. Both positive and negative experiences were explored. Problematic experiences including time-constrained consultations ('You're a number, and that's where I feel like a sheep and [that] can stress you out more'), having to self-advocate for care, and guilt about smoking were common. Positive care experiences described non-judgemental interpersonal interactions with doctors, timely referral, proactive care and trust ('I have an actual great trust for my GP. they're awesome, they'll look after you'). Conclusion(s): Pro-active, empathetic care from GPs is desired by patients living with COPD who continue to smoke but this is not always reflected in the lived experience of care. Stigma and fear of judgement were important underlying drivers of negative care experiences and need to be carefully considered in provision of care for this group.
ABSTRACT
Background: Studies of adults living with Chronic Obstructive Pulmonary Disease (COPD) reveal a number of challenges when interacting with healthcare providers and may be exacerbated by unwillingness or inability to quit smoking. However, none have explored in-depth, primary care experiences among patients with COPD in the Australian healthcare setting. Aim/Objectives: The study used Interpretive Phenomenological Analysis (IPA) to explore healthcare experiences of participants in primary care settings amongst current smokers or those who had recently quit smoking. Method(s): The study was guided by principles of IPA and participants' sense-making of their personal and social 'world', particular experiences, events and emotions were explored. Thirteen participants were purposively recruited from 33 responses to social media posts in COPD and carer support groups, general community groups, community noticeboards and paid adverts. In-depth interviews were held between February and April 2022 by phone or Zoom. Interviews explored healthcare experiences, smoking and stigma. Cross-case analysis was conducted to form group experiential themes. Finding(s): Participants self-reported doctor diagnosed COPD, were living in Australia and aged between 45 to 75 years. Nine were female and 60% were current smokers. Interviews explored experiences of care including access, interpersonal care, coordination, comprehensiveness of services and trust. Participants described how their care experience shifted as primary care adapted care delivery during COVID. Problematic experiences included timeconstrained consultations 'You're a number, and that's where I feel like a sheep and they can stress you out more', having to self-advocate for care and guilt about smoking. Positive care experiences described non-judgemental interpersonal interactions with doctors, timely referral, proactive care and trust 'I have an actual great trust for my GP they're awesome, they'll look after you'. Implications: Understanding and valuing the patient experience in healthcare interactions provides insights to how care can be transformed for vulnerable patients living with socially stigmatised illness.