Case-finding for COPD in primary care: a qualitative study of patients’ perspectives

Alexandra Enocson, Kate Jolly, Rachel Elizabeth Jordan, David A Fitzmaurice, SM Greenfield, Peymane Adab

On behalf of the BLISS research team

Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, West Midlands, UK

Background: COPD is a leading cause of morbidity and mortality, yet it remains largely underdiagnosed. Case-finding is encouraged by many professionals, but there is a lack of information on the patients’ views and perspectives.
Patients and methods: Semistructured interviews were conducted with adults, aged 40 years or older with a history of smoking, who were eligible and invited for case-finding for COPD as a part of a large UK primary care trial. Patients, including those who consented or declined participation and those with and without COPD after screen­ing, were interviewed. Interviews were transcribed and analyzed using the framework method.
Results: The 43 interviews revealed the following two main categories of themes: patients’ views on COPD case-finding and barriers to case-finding. Overall, case-finding was deemed important and beneficial. Partici­pants highlighted the need for screening activities to be convenient for patients but perceived that general practitioners (GPs) lacked the time and accessing appointments was difficult. Desire for a health check among symptomatic patients facilitated participation in case-finding. Psychological barriers to engagement included denial of ill health or failure to recognize symptoms, fear of the “test”, and lung symptoms being low on the hierarchy of patient health complaints. Mechanical barriers included providing care for another person (and therefore being too busy), being unable to access GP appointments, and lacking feedback of spirometry results or communication of the diagnosis.
Conclusion: Patient engagement with case-finding may be limited by denial or lack of recognition of symptoms and physical barriers to attendance. Increasing public awareness of COPD risk factors and early symptoms may enhance case-finding.

Keywords: COPD, screening, qualitative research, primary care