Facilitators and barriers to clinicians' use of COPD action plans in self-management support: A qualitative study

Abstract

Objective: Written action plans for patients with chronic obstructive pulmonary disease (COPD) aim at early recognition of exacerbations and self-initiation of interventions. Previous research suggest underuse of COPD action plans. We wanted to 1) examine which factors clinicians in specialist healthcare perceived as influencing clinicians' use of written action plans in COPD-self management support and 2) propose a framework for understanding the factors affecting clinicians' use of action plans in routine practice.

Methods: We performed a theory-driven retrospective qualitative study. Documentary data were collected to describe the COPD action plan in context. In-depth interviews with clinicians (n = 8) were carried out. Interview data were thematically analyzed, using a predetermined model for understanding behavior.

Results: Our study revealed that a number of factors influenced clinicians' use of action plans, including their capabilities (knowledge and skills to identify "the right patient" and to individualize the plan template) and motivations (beliefs, reinforcements, and emotions s.a. frustration, fear, and distrust), together with organizational and social opportunities (resources, patient, and GP preferences).

Conclusion: A multilevel understanding of factors that affect clinicians' use of action plans in self-management support is needed.

Practice implication: The proposed framework can be used to guide future initiatives to promote targeted self-management support.

Keywords: Action plans; COM-B; COPD; Exacerbations; Implementation; Qualitative; Self-management.