A menu based approach to improve uptake and completion of pulmonary rehabilitation programmes for individuals with COPD

Pulmonary Rehabilitation (PR) is evidenced-based for individuals living with Chronic Obstructive Pulmonary Disease (COPD) and, upon referral, a menu of options is available. However, uptake and completion remains challenging. There is growing interest in shared decision making (SDM) to support individuals and healthcare professionals (HCPs) make optimal healthcare decisions. However, its adoption within PR is in its infancy and currently no interventions to facilitate SDM exist. This thesis sought to design and develop an intervention to facilitate SDM between individuals and HCPs about PR treatment options that was feasible and acceptable to all. Qualitative, quantitative, and systematic review methodology were adopted to inform the intervention’s design (chapters 2, 3, and 4). A systematic development process was implemented (chapter 5). A mixed methods study evaluated its feasibility and acceptability with individuals with COPD and PR HCPs (chapter 6). Whilst there was an appetite for a menu-based approach, facilitated by SDM, barriers to its adoption included: individuals and HCPs having insufficient knowledge of the menu and HCPs not viewing the options equally. All expressed a need for a knowledge translation and decision support tool to facilitate SDM into PR decision-making (chapter 2). Chapter 3 showed that HCPs exhibit implicit bis towards the COPD health behaviours smoking and exercising. As implicit (and explicit) bias influence behaviours, these results in collaboration with findings from chapter 2 provided an argument for the inclusion of training to upskill HCPs in SDM, including the importance of unbiased communications. The systematic review (chapter 4) showed a three-pronged SDM intervention including components at the individual, the HCP, and the consultation level could facilitate SDM in PR. The developed intervention included a patient decision aid, decision coaching training for PR HCPs, and a consultation prompt (chapter 5). Upon testing, the intervention proved feasible, acceptable, and could be delivered with fidelity.