The Unmet Needs of People with Chronic Obstructive Pulmonary Disease: A Systematic Review of Qualitative Findings

Figures & data

Figure 1. Literature identification process.

Table 1. Characteristics of the included studies.

Author/Year [code]	Country/Setting	Aim	Population	Method	Data collection	Data analysis	Methodological quality appraisal^a
Wilson et al. 2008 (20) [A]	Canada, Community	Determine the care needs of community-dwelling Canadian elderly patients with advanced COPD	12 advanced COPD patients in oxygen therapyAge > 64 yearsNo sociodemographic data specified	Ethnography	Individual repeated interviews, observations	Constant comparative	9/10
Gruffydd-Jones et al. 2007 (21) [B]	UK, Community	Identify the needs of COPD patients following discharge from hospital after an acute exacerbation	6 patients after hospital dischargeNo sociodemographic data specified	Qualitative descriptive	Focus groups	Thematic analysis	9/10
Wong et al, 2014 (22) [C]	Malaysia, Hospital, community	Explore the unmet needs of patients with COPD that could improve the quality of life^b	18 menMean age (range) = 72.3 years (52–89)FEV1/FVC (mean) = 59% (SD 12.8%)	Qualitative descriptive	Focus groups	Thematic analysis	10/10
Crawford et al. 2012 (23) [D]	Australia, Community	Explore the needs of patients with end-stage COPD to develop recommendations for a model of care^b	15 advanced COPD stage patients (9 men)Mean age (range) = 67 years (53–79)7 singles, 8 married	Qualitative descriptive	Individual interviews	Thematic analysis	7/10
Philip et al. 2011 (24) [E]	Australia, Community	Explore the point of view of patients with COPD and healthcare professional focusing on information needs and treatment preferences^b	10 patients (6 men)Median age (range) = 67 years (55–76)3 patients in oxygen therapy	Qualitative descriptive	Individual interviews	Thematic analysis	9/10
Ellison et al. 2012 (25) [F]	UK, Community	Understand the mental health needs of patients with COPD	14 patients (7 men)Mean age (range) = 64 years (49–79)7 patients with caregiver	Qualitative descriptive	Individual interviews	Constant comparative	9/10
Schroedl et al. 2014 (26) [G]	USA, Hospital	Identify the unmet healthcare needs of patients with COPD hospitalized for acute exacerbation	20 patients (9 men)Median age (range) = 69 years (52–83)6 Caucasians, 12 Black-Americans, 2 Asians5 married, 15 singlesMedian FEV1 (range) = 39% (22%–69%)	Qualitative descriptive	Individual interviews	Thematic analysis	8/10
Hasson et al. 2008 (27) [H]	UK, Community	Explore the potential of palliative care among people with end-stage COPD	13 patients (10 men)Median age (range) = 65 years (45–65)Length of COPD: 1 to 10 years	Qualitative descriptive	Individual interviews	Thematic analysis	9/10

COPD = chronic obstructive pulmonary disease; FEV1 = forced expiratory volume in the 1st second; FVC = forced vital capacity; SD = standard deviation.

^a According to JBI-QARI critical appraisal tool.

^b Only data about COPD patient were extracted.

Table 2. Synthesized findings, categories, and findings extracted from the included studies.

Synthetized findings	Categories	Study findings
People with COPD have unmet needs regarding information about the disease	Unmet needs around knowledge of COPD terminology, aetiology and prognosisUnmet needs regarding knowledge of disease managementUnmet needs regarding information on end-of-life and palliative care	Terminology [C1]Nature of COPD [D1]Understanding of disease (diagnosis, severity, and prognosis) [G1]Educational needs [B4]Knowledge of disease [C2]The utility of self-management [C5]Experiencing treatment [F4]Information and support needs [H4]Advanced care planning [D6]Optimism and treatment decisions [E1]Burden versus benefit of treatment [E2]Information and end-life discussions [E3]Views of palliative care in COPD [E4]Palliative care approach [H5]
People with COPD have unmet physical, emotional and social needs, due to the disease symptoms and treatments	Unmet physical/daily living needs	Maintaining independence [A1]Living with constraints (physical) [A2]Physical impact (physical) [C4]Impact of COPD (physical/ADL) [D2]Home oxygen (physical) [D7]Uncontrolled symptoms [G2]Physical limitations [G3]Physical and psychological effects (physical) [H1]
	Unmet emotional needs	Fear and anxiety associated with acute attacks of breathlessness [B2]
		Psychosocial limitations (emotional) [C3]
		Impact of COPD (emotional) [D2]
		Home oxygen (emotional) [D7]
		Changing identity [F1]
		Isolation and fear of dependence [F2]
		Unmet needs [F5]
		Meeting unmet need [F6]
		Emotional distress [G4]
		Concerns for the future [G6]
		Physical and psychological effects (emotional) [H1]
	Unmet needs regarding social support	Psychosocial limitations (social) [C3]
		Impact of COPD (social) [D2]
		Social isolation [G5]
		Perceived impact on carers [H2]
	Unmet needs regarding financial support	Living with constraints (financial) [A2]
		Home oxygen (financial) [D7]
People with COPD have unmet care needs	Unmet needs for accessibility to healthcare professionals	Living with constraints (accessible healthcare providers) [A2]
		Reluctance to seek medical help in an exacerbation [B1]
		Follow-up after hospital [B3]
		Communication [D5]
		Health and social support [H3]
	Unmet care need for access to healthcare services	Living with constraints (transportation) [A2]
		Physical impact (environmental barriers) [C4]
		Access to community services [D3]
		Care coordination [D4]
		Barriers to accessing care [F3]

ADL = activities of daily living; COPD = chronic obstructive pulmonary disease.

Studies code: A (20); B (21); C (22); D (23); E (24); F (25); G (26); H (27). The number beside the capital letter indicates the order in which the study findings were presented in the original article.

Wilson DM, Ross C, Goodridge D, Davis P, Landreville A, Roebuck K. The care needs of community-dwelling seniors suffering from advanced chronic obstructive pulmonary disease. Can J Aging. 2008;27(4):347–57. doi:10.3138/cja.27.4.347. PMID: 19416796

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Gruffydd-Jones K, Langley-Johnson C, Dyer C, Badlan K, Ward S. What are the needs of patients following discharge from hospital after an acute exacerbation of chronic obstructive pulmonary disease (COPD)? Prim Care Respir J. 2007;16(6):363–8. doi:10.3132/pcrj.2007.00075. PMID: 18038104

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Philip J, Gold M, Brand C, Douglass J, Miller B, Sundararajan V. Negotiating hope with chronic obstructive pulmonary disease patients: a qualitative study of patients and healthcare professionals. Intern Med J. 2012;42(7):816–22. doi:10.1111/j.1445-5994.2011.02641.x. PMID: 22152049

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Ellison L, Gask L, Bakerly ND, Roberts J. Meeting the mental health needs of people with chronic obstructive pulmonary disease: a qualitative study. Chronic Illn. 2012;8(4):308–20. doi:10.1177/1742395312449754. PMID: 22659349

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Schroedl CJ, Yount SE, Szmuilowicz E, Hutchison PJ, Rosenberg SR, Kalhan R. A qualitative study of unmet healthcare needs in chronic obstructive pulmonary disease. A potential role for specialist palliative care? Ann Am Thorac Soc. 2014;11(9):1433–8. doi:10.1513/AnnalsATS.201404-155BC. PMID: 25302521

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Hasson F, Spence A, Waldron M, Kernohan G, McLaughlin D, Watson B, Cochrane B. I can not get a breath: experiences of living with advanced chronic obstructive pulmonary disease. Int J Palliat Nurs. 2008;14(11):526–31. doi:10.12968/ijpn.2008.14.11.31756.

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