The roles of dispositional coping style and social support in helping people with respiratory disease cope with a breathlessness crisis.

Maja Villanueva Garcia,Ann Hutchinson,Miriam Johnson,Tim Luckett,Sara Lal,Jane L Phillips

doi:10.1111/jan.14039

Maja Villanueva Garcia, Ann Hutchinson + Show 4 more

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https://doi.org/10.1111/jan.14039

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Abstract

To explore the role of coping moderators in self-management of breathlessness crises by people with advanced respiratory disease. A secondary analysis of semi-structured interview data. Interviews with patients who had advanced respiratory disease, chronic breathlessness and at least one experience where they considered presenting to Emergency but self-managed instead (a "near miss"). Participants were recruited from New South Wales, Queensland, Victoria, South Australia or Tasmania. Eligible caregivers were those who contributed to Emergency-related decision-making. Interviews were coded inductively and then deductively against the coping moderators social support and dispositional coping style, defined by the Transactional Model of Stress and Coping. Interviews were conducted between October 2015 - April 2016 with 20 patients and three caregivers. Social networks offered emotional and practical support but also had potential for conflict with patients' 'hardy' coping style. Patient hardiness (characterized by a sense of 'commitment' and 'challenge') promoted a proactive approach to self-management but made some patients less willing to accept support. Information-seeking tendencies varied between patients and were sometimes shared with caregivers. An optimistic coping style appeared to be less equivocally beneficial. This study shows that social support and coping style may influence how people self-manage through their breathlessness crises and identified ways coping moderators can facilitate or hinder effective self-management. This study confers insights into how social-support and coping style can be supported and optimized to facilitate breathlessness self-management. Acknowledging coping moderator interactions is beneficial for developing resources and strategies that recognise patient mastery.

Highlights

Chronic breathlessness is defined as breathlessness that persists despite optimal treatment of the underlying pathophysiology and results in disability (Johnson et al, 2017)
Previous studies of people with chronic obstructive pulmonary disease (COPD) have found social support to be a source of safety and security (Kanervisto, Kaistila, & Paavilainen, 2007) and to be a calming presence during a crisis (Disler et al, 2014). While this was echoed in our study, similar to other research we found that family members are distressed by breathlessness crises, sometimes more so than the person with breathlessness themselves (Gysels, Bausewein, & Higginson, 2007), with the result that they are less able to positively contribute to patient coping
Coping moderators appear to influence the ways people with breathlessness cope with a crisis in most aspects of the coping process, as well as the decision whether or not to present to Emergency Department (ED)

Summary

Introduction

Chronic breathlessness is defined as breathlessness that persists despite optimal treatment of the underlying pathophysiology and results in disability (Johnson et al, 2017). It is associated with many advanced chronic conditions and respiratory disease such as chronic obstructive pulmonary disease (COPD) where breathlessness is almost universal (Moens et al, 2014). When applied to patient experiences of breathlessness crises, the Transactional Model has suggested that the most important factors in avoiding ED presentation are perceived control over the crisis and self-efficacy in managing the affective dimension of experience (Luckett et al, 2017)

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