Illness representations and coping strategies during exacerbation of COPD: A qualitative descriptive study

Background: How individuals with COPD recognize and respond to symptoms of impending exacerbation is important to understand in order to develop appropriate self-care interventions. Aims: The aim of this study was to describe illness representation, coping strategies and subsequent appraisal by patients during an acute exacerbation of COPD. Methods: Fourteen patients hospitalized for an acute exacerbation of COPD participated in this qualitative descriptive study. Semi-structured interviews were conducted following an interview guide informed by Leventhal’s Common-Sense Model of Illness Representation. The 5 dimensions of illness representation identity, cause, consequence, timeline and control were explored. Interviews were transcribed and underwent content analysis. Findings: Although all patients recognized a change in their baseline health status, only four participants identified the change as a COPD exacerbation at the outset of the event. Most participants took a wait and see approach and managed symptoms with rest and inhalers until they could no longer control symptoms and required emergency healthcare services. The emotional processing dimension of illness representation greatly influenced coping behavior. Anticipated stigma, distain for hospitals, and scheduled social engagements influenced coping strategies and contributed to treatment delay (mean = 7 days). Conclusions: The Common-Sense Model was a useful framework for exploring patient recognition and response to COPD exacerbation. Nursing interventions aimed at improving self-care monitoring, self-care management and early treatment seeking for exacerbation of COPD are needed to improve health outcomes.