COPD-Related Anxiety: A Systematic Review of Patient Perspectives

Figures & data

Figure 1 PRISMA flow diagram of the study selection process. From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. Creative Commons. For more information, visit: http://www.prisma-statement.org/.

Table 1 Study Characteristics

Reference, Year Country	Study Objectives (Type of Analysis)	N^a	Mean Age^b	% Female	Disease Severity^c
Bakthavatsalu et al, 2023^Citation21 India	To understand the lives experience of hospitalization in advanced COPD (phenomenological, descriptive)	15	66.2 (61–83)	33.3	Stage III and IV
Skär et al, 2023^Citation22 Sweden	To deepen knowledge of how patients with COPD and LOTT think about and expect end-of-life (hermeneutic)	19	74.3 (3.6)	63.2	-
Zanolari et al, 2023^Citation23 Switzerland	To identify sources of illness-related emotional distress (rule-based)	11	67 (51–81)	63.6	50 (17–96)
Lin & Shune, 2022^Citation24 USA	To understand the experience of oral intake for individuals with COPD (grounded theory)	14	68.9 (49–88)	50	-
Ekdahl et al, 2022^Citation19 Sweden	To describe women’s experiences of living with COPD (content analysis)	15	75 (50–84)	100	Stage III and IV
Gilliam et al, 2021^Citation25 USA	To gain insights into biopsychosocial experiences of COPD within the context of Tai Chi (social constructivist)	54	68.5 (8.3)	48.2	48.8 (16.4)
Jørgensen et al, 2021^Citation26 Denmark	To explore patients’ experiences of admission due to acute exacerbation of COPD (meaning condensation)	13	68.5 (50–86)	61.5	-
Askey-Jones et al, 2020^Citation27 UK	To explore patients’ experiences of a psychoeducation session in pulmonary rehabilitation (thematic analysis)	12	70 (34–91)	NR	-
Lundell et al, 2020^Citation28 Sweden	To explore how patients with COPD experience interactions in healthcare professionals (grounded theory)	13	69 (48–80)	61.5	52 (28–91)
Rubio, 2019^Citation29 USA	To examine experiences, feelings and perceptions of living with stage IV COPD (phenomenological, interpretative)	6	70	66.6	20
Sigurgeirsdottir et al, 2019^Citation30 Iceland	To explore patients experiences, needs and coping strategies in COPD (phenomenological, hermeneutic)	10	69.2 (59–74)	30	40.4 (21–83)
Slevin et al, 2019^Citation31 Ireland	To explore potential benefits of digital health technologies in COPD (thematic analysis)	30	68.2 (10.1)	43.3	I: 2 II: 16 III: 9 IV: 3
Wu et al, 2019^Citation32 Canada	To determine patients’ needs in wearable devices for management of COPD (thematic analysis)	14	69 (62–81)	50	-
Jarab et al, 2018^Citation33 Jordan	To explore patients’ perspectives on the impact of COPD on quality of life (thematic analysis)	28	-	-	-
Østergaard et al, 2018^Citation34 Denmark	To explore barriers and motivation regarding physical activity in COPD (thematic analysis)	5	59.4 (39–75)	80	-
Luckett et al 2017^Citation35 Australia	To seek insights from people with emergency department’s “near misses” in COPD (integrative)	20	>65 yrs: 75%	45	-
Bove et al, 2017^Citation36 Denmark	To explore patients’ experience of home-based psychoeducation (interpretive descriptive)	20	69 (54–88)	70	32 (14–57)
Korpershoek et al, 2016^Citation37 Netherlands	To explore factors related to self-management of COPD exacerbations (grounded theory)	15	70 (59–88)	46.7	I: 2 II: 5 III: 7 IV: 1
Halpin et al, 2015^Citation38 UK	To understand the experience of fear and anxiety in patients with COPD exacerbation (thematic analysis)	20	67 (47–84)	65	-
Strömberg et al, 2015^Citation39 Sweden	To describe patients’ thought and attitudes towards exercise in COPD (grounded theory)	10	75.2 (66–84)	60	53.5 (30–72)
Gabriel et al, 2014^Citation40 Portugal	To explore the impact of COPD on family life (thematic analysis)	20	74.1 (8.5)	20	37.3 (8.4)
Kauffman et al, 2014^Citation41 USA	To describe experiences of insomnia, symptom attribution and treatment preferences in COPD (thematic analysis)	18	57.6 (49–75)	35	-
Schroedl et al, 2014^Citation42 USA	To identify unmet needs of hospitalized patients with COPD (thematic analysis)	20	69 (52–83)	55	39 (22–69)
Strang et al, 2014^Citation43 Sweden	To explore the patients’ experience of anxiety in COPD (thematic analysis)	31	69.3 (48–85)	51.6	35.3
Hayle et al, 2013^Citation44 UK	To evaluate patients’ experiences of specialized palliative care in COPD (phenomenological, hermeneutic)	8	68.6 (63–77)	37.5	-
Panos et al, 2013^Citation20 USA	To explore patient-reported determinants of health in COPD (inductive)	42	64.6 (1.4)	0	-
Ellison et al, 2012^Citation45 UK	To understand the mental health needs of people with COPD (thematic analysis)	14	64 (10.5)	50	40 (13)
Willgoss et al, 2012^Citation46 UK	To elicit and describe experiences of anxiety in people with COPD (thematic analysis)	14	62.3 (9.9)	64.3	-
Wortz et al, 2012^Citation47 USA	To explore patients’ goals and expectations for self-management of COPD (thematic analysis)	47	68.4 (9.3)	46.8	-
Sossai et al, 2011^Citation48 Australia	To explore patients’ experiences of living with COPD (thematic analysis)	8	- (55–80)	37.5	-
Willgoss et al, 2011^Citation11 UK	To explore patients’ experience of living and coping with anxiety in COPD (framework analysis)	14	- (43–76)	64.3	-
Lewis et al, 2010^Citation49 UK	To describe facilitators and barriers to exercise maintenance in COPD (thematic analysis)	6	69.3 (61–83)	83.3	-
Lohne et al, 2010^Citation50 Norway	To evaluate pain experiences of patients with COPD (meaning condensation)	16	57.9 (4.1)	75	17 (582)
Torheim et al, 2010^Citation51 Norway	To explore experiences of mask treatment in patients with acute COPD exacerbation (phenomenological)	5	- (45–78)	60	-
Clancy et al, 2009^Citation52 UK	To describe the meaning of living with COPD (phenomenological, hermeneutic)	10	68.9	40	-
Gardiner et al, 2009^Citation53 UK	To determine the needs of patients in advanced COPD (thematic analysis)	21	70.3 (7.5)	38.1	-
Harris et al, 2008^Citation54 UK	To identify a strategy for improving pulmonary rehabilitation uptake in COPD (grounded theory)	16	66.8 (6.9)	25	-
Kessler et al, 2006^Citation18 Multiple, Europe	To gain insight into patients’ experiences of COPD exacerbation (thematic analysis)	125	66.4 (8.5)	34.5	40.9 (18.1)
Barnett et al, 2005^Citation55 UK	To explore the experience of living with COPD (hermeneutic)	10	-	-	-
Jones et al, 2004^Citation56 UK	To explore compliance with medication and lifestyle modification in COPD (thematic analysis)	29	67 (51–79)	31	-
Jeng et al, 2002^Citation57 Taiwan	To explore patients’ experiences of daily life after hospital discharge in COPD (content analysis)	9	- (65–80)	22.2	-

Notes: ^aN denotes the number of participants interviewed in the study; ^bMean age reported with standard deviation or range; ^cDisease severity reported as mean predicted forced expiratory volume in the first second (FEV1) with standard deviation or range. When not available, disease severity is reported as GOLD stage frequencies.

Table 2 Data Supporting Themes

Reference, Year	Theme 1: Initial Events	Theme 2: Internal Maintaining	Theme 3: External Maintaining	Theme4: Behavioral Maintaining
Askey-Jones et al 2020^Citation27			X
Bakthavatsalu et al, 2023^Citation21	X	X	X
Barnett 2005^Citation55	X	X	X
Bove et al 2017^Citation36	X	X	X	X
Clancy et al, 2009^Citation52	X	X		X
Ekdahl et al, 2021^Citation19	X	X	X
Ellison et al, 2012^Citation45			X
Gabriel et al, 2014^Citation40	X
Gardiner et al, 2009^Citation53	X	X	X
Gilliam et al, 2021^Citation25		X	X
Halpin et al, 2015^Citation38		X
Harris et al, 2008^Citation54			X	X
Hayle et al, 2013^Citation44	X	X
Jarab et al, 2018^Citation33		X	X
Jeng et al, 2002^Citation57		X	X	X
Jones et al, 2004^Citation56	X
Jørgensen et al, 2021^Citation26	X	X	X	X
Kauffman et al, 2014^Citation41		X	X
Kessler et al, 2006^Citation18	X	X
Korpershoek et al, 2016^Citation37	X			X
Lewis et al, 2010^Citation49		X		X
Lohne et al, 2010^Citation50	X
Luckett et al, 2017^Citation35	X	X	X	X
Lundell et al, 2020^Citation28	X	X	X
Panos et al, 2013^Citation20		X
Rubio 2019^Citation29	X	X
Schroedl et al, 2014^Citation42	X	X
Sigurgeirsdottir et al, 2019^Citation30		X
Skär et al, 2023^Citation22	X	X	X
Slevin et al, 2019^Citation31	X
Sossai et al, 2011^Citation48	X			X
Strang et al, 2014^Citation43	X	X	X	X
Strömberg et al, 2015^Citation39	X	X
Lin & Shune, 2022^Citation24	X	X		X
Torheim et al, 2010^Citation51		X
Willgoss et al, 2011^Citation11	X	X	X
Willgoss et al, 2012^Citation46	X	X
Wortz et al, 2012^Citation47		X
Wu et al, 2019^Citation32	X
Zanolari et al, 2023^Citation23	X	X	X	X
Østergaard et al, 2018^Citation34	X	X		X

Figure 2 Conceptual model of COPD-related anxiety from the patient perspective.

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