Abstract
SummaryAdherence to continuous positive airway pressure treatment for obstructive sleep apnea tends to be poor. Communication influences adherence but has not previously been investigated from a practitioner perspective, although shared decision‐making is known to be of great importance. The aim was to describe how practitioners experience communication with patients with obstructive sleep apnea during the initial visit at a continuous positive airway pressure treatment clinic, with focus on facilitators and barriers related to the 4 Habits Model, a communication model comprised of four types of interrelated skills to make encounters more patient‐centred: investing in the beginning; exploring the patient perspective; showing empathy; and investing in the end. A descriptive design with qualitative content analysis was used. A deductive analysis was carried out based on interviews with 24 strategically selected practitioners from seven continuous positive airway pressure treatment clinics. The 4 Habits Model was used as a framework for identifying facilitators and barriers to communication. Investments in the beginning was described as creating contact, showing the agenda and being adaptive, while explore the patient perspective included showing awareness, being explorative and creating a participating climate. Show empathy consisted of showing openness, being confirmative and creating acceptance, while showing a structured follow‐up plan, being open minded and invitational and creating motivation to build on were descriptions of invest in the end. Awareness of potential facilitators and barriers for patient‐centred communication during the beginning, middle and end of a continuous positive airway pressure treatment consultation can be used to improve contextual conditions and personal communication competences among practitioners working with continuous positive airway pressure treatment initiation.
Highlights
Obstructive sleep apnea (OSA) is a chronic and highly prevalent public health problem in which the soft tissue of the upper airways collapses during sleep, leading to obstructive apneas and hypopneas (Senaratna et al, 2017)
Facilitators and barriers to achieving patient-centred communication between practitioners and patients during the initial visit to a Continuous positive airway pressure (CPAP) clinic have not been investigated from the perspective of practitioners, despite the potential importance of such communication for shared decision-making (Charles et al, 1997)
We aimed to describe how practitioners experience communication with patients with OSA during the initial visit at a CPAP clinic, with focus on facilitators and barriers related to the 4 Habits Model
Summary
Obstructive sleep apnea (OSA) is a chronic and highly prevalent public health problem in which the soft tissue of the upper airways collapses during sleep, leading to obstructive apneas and hypopneas (Senaratna et al, 2017). Continuous positive airway pressure (CPAP), a device that prevents the airways from collapsing by creating a positive airway pressure during sleep, has been offered to patients with OSA during the last 20 years (Rotenberg et al, 2016). Flaws in communication about motivational and behavioural aspects (e.g. attitudes, self-efficacy, illness and treatment beliefs; Broström et al, 2011; Crawford et al, 2014; Ward et al, 2014), need for self-care actions, and handling of side-effects (Ulander et al, 2014) have been reported as important barriers to adherence (Bakker et al, 2019). Excessive daytime sleepiness (i.e. to the extent that some patients may literally fall asleep during consultations) and cognitive dysfunction due to chronic poor sleep (Tietjens et al, 2019) may negatively affect the ability to participate in patient education and shared decision-making. Facilitators and barriers to achieving patient-centred communication between practitioners and patients during the initial visit to a CPAP clinic have not been investigated from the perspective of practitioners, despite the potential importance of such communication for shared decision-making (Charles et al, 1997)
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