Development of a self-treatment approach for patients with COPD and comorbidities: an ongoing learning process

Tanja Effing-Tijdhof, Anke Lenferink, Julie Buckman, Deborah Spicer, Paul Cafarella, Morton Burt, Katherine Bassett, Clara van Ommeren, Sally Anesbury, Paul van der Valk, Peter Frith, Job van der Palen

    Research output: Contribution to journalReview articlepeer-review

    10 Citations (Scopus)


    Background: Patient-initiated action plans are an important component of COPD self-management (SM) interventions. When integrated into SM interventions, these action plans have proven to be effective in reducing exacerbation severity, hospitalisations, and costs and in improving health status in patients with COPD without severe comorbidities. Because of overlap in symptoms, a self-treatment (ST) approach that focuses solely on traditional symptoms of COPD is inadequate for patients with COPD and comorbidities. The COPE-III SM intervention combines (I) patient-initiated action plans that are tailored to the individual's co-morbid disease(s), and (II) ongoing nurse support. In this paper we provide information regarding the integration of information from two previous COPD SM studies (COPE I and II) in the development of the current COPE-III ST approach. Materials and methods: COPE-III ST materials include daily symptom diaries and action plans that take patient's common comorbidities [chronic heart failure (CHF), anxiety, depression, ischaemic heart disease (IHD), and diabetes] into account. The comorbid diary and action plans components were developed in collaboration with multiple disease-experts. Results: Previous SM studies have highlighted some essential topics that need to be considered when developing a SM or ST approach: 'when to initiate ST', 'how to optimize materials and safety', and 'how to achieve behavioural change'. In the COPE-III study, ST is initiated after a significant change in symptoms. This is consistent with the COPE-II approach and was implemented because disease symptoms are often present even when patients are stable. We have tried to ensure patient safety by providing an easily accessible case-manager to patients throughout their involvement in the study. Furthermore, a psychologist has ensured the use of behavioural change techniques throughout the intervention. Conclusions: We should continue to learn from our experiences with SM interventions to further optimize future SM and ST interventions. The use of materials that are suitable for different levels of patient literacy and the training of health care providers are other points of improvement.

    Original languageEnglish
    Pages (from-to)1597-1605
    Number of pages9
    JournalJournal of Thoracic Disease
    Issue number11
    Publication statusPublished - 2014


    • Chronic obstructive
    • Comorbidity
    • Pulmonary disease
    • Self-care


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