Development of a Pulmonary Rehabilitation Patient Decision Aid for Patients with Chronic Obstructive Pulmonary Disease: Mixed Methods Study

Abstract

Background

Pulmonary rehabilitation is an important part of the management of chronic obstructive pulmonary disease (COPD), but the participation rate of pulmonary rehabilitation in COPD patients is low. Patient decision aids can facilitate patient participation in pulmonary rehabilitation decisions by providing information and incorporating patient values. The aim of this study was to develop a pulmonary rehabilitation decision aid for patients with COPD.

Objective

The aim of this study was to develop a WeChat-based pulmonary rehabilitation patient decision aid to help older patients with COPD participate in pulmonary rehabilitation decision-making.

Methods

We developed the decision aid in 3 stages: (1) a literature review was performed to determine the evidence for pulmonary rehabilitation options and outcomes for patients with COPD. (2) a semi-structured interview study was conducted to develop and iterate patient decision aids. (3) usability, acceptability and language expression testing in patients and healthcare professionals.

Results

A total of 16 randomized controlled studies were included in the literature review. Thirty-six participants received semi-structured interviews. The results of interview include four themes: key points of age-friendly design, content of the tool, presentation requirements of contents and study evidence of the tool and other views and suggestions. The resultant goals-of-care decision aid achieved good usability and acceptability. The frequency of language expression increased in both patients and healthcare professionals.

Conclusion

This study uses a systematic development process to develop the first pulmonary rehabilitation decision aid for patients with COPD. It has good usability, acceptability and increased communication between patients and healthcare professionals in the pulmonary rehabilitation decision-making process.

Trial Registration

Chinese Clinical Trial Registry (ChiCTR): ChiCTR1900028563; http://apps.who.int/trialsearch/default.aspx.

Keywords:

• chronic obstructive pulmonary disease
• shared decision making
• pulmonary rehabilitation
• patient decision aid

Abbreviations

COPD, chronic obstructive pulmonary disease; SDM, shared decision-making; PtDAs, patient decision aids; NVC, non-violent communication; HCPs, healthcare professionals; OPDG, Ottawa Personal Decision Guide; RCTs, randomised controlled trials; SUS, System Usability Scale.

Data Sharing Statement

The data that support the findings of this study are available from http://apps.who.int/trialsearch/default.aspx.

Ethics Approval

This study was approved by the Medical Ethics Committee of Jiangnan University (JNU20200109IRB01) and conducted in line with Helsinki Declaration principles.

Informed Consent

Informed consent has been provided by all participants.

Acknowledgments

This study was supported by the Wuxi Municipal Bureau on Science and Technology (CN) (Grant N20192046) and National Natural Science Foundation of China (72274080). The authors are grateful for the assistance of the hospitals and wish to extend special thanks to all interviewees.

Disclosure

The authors report no conflicts of interest in this work.