Collaborative self-management in chronic obstructive pulmonary disease

The past 10 years have been the witness of several manuscripts about chronic obstructive pulmonary disease (COPD) self-management, particularly to those aimed to diminish the impact of COPD exacerbations. Those publications opened an aspect in the treatment of COPD for which there was no awareness before, which included the active participation of patients in their own care, a participatory model.

While self-management happens in every human being, as it relates to how we live our lives – the decisions and actions we constantly do ‘or not do’ – in a moment by moment basis, for individuals that suffer a chronic disease, those self management actions can have a profound effect in their well-being, disease trajectory and health outcomes.

In COPD, self-management has been primarily associated with the use of written prescription of an antibiotic and steroids for early signs of COPD exacerbations, not because it is not applicable to other aspects of COPD care, but due to the only available literature. In reality, self-management has universal applications in the chronic disease process, to name a few are use of medications, physical activity, eating, emotional control, and so on. In COPD exacerbation treatment, at least two randomized studies on self-management showed a decrease in health care utilization. ^1,2 However, other randomized studies failed to show a difference indicating that the mere prescription of a written action plan is necessary but not sufficient to translate in benefits. ^3,4 The analysis of negative studies seems to show that a patient activation, the behavior of the patient to use the prescriptive plan, is a critical part of the self-management process, which goes far beyond prescription of an action. The latter is likely the most critical lesson learned from all these pioneer studies, the fact that a behavior change is needed to make a difference in outcomes.

The actual know-how, ‘the way’ to generate a behavior change in patient, is not well known; however, a few characteristics that may create a fertile environment for behavior change are: honoring patient autonomy, letting the patient decide to change or not to change, considering them as experts in living with COPD, deep listening from the interventionist and promoting self efficacy. ^5,6

This series of ‘collaborative self-management’ aims to provide the reader different methods and prospective about how self-management as is practiced in three different health care environments (the Netherlands, Canada and the United States). Several theories related to creativity, patient-centeredness and behavior change will be discussed along the series, which are self-efficacy, stage of change, ⁷ motivational interviewing, ⁶ mindfulness, ⁸ and tools used in those approaches. The ultimate intention is to ignite the reader into an exploration into what might be possible in their own environment.

In this series, the word collaborative in the title is not an accident. The delivery of a lifestyle–self-management intervention also requires a deep preparation in the provider to create the right environment that may promote a behavior change. It is not a passive delivery; a connection and full embodiment of the intervention need to occur in the provider. Most likely, the success for any intervention depends on the inner state of the intervener.

There is a long road to transit in this quest for learning ways to promote patient motivation and behavioral change, critical ingredients for patients’ well-being and hopefully better disease trajectory. New knowledge is needed from future interventions based on the creativity that arises from the observation and empathy with individual situations, patients and care settings.

It is our intention that this offering contributes to such a purpose.