Comparing patient and professional views of expected treatment outcomes for chronic obstructive pulmonary disease: A Delphi study identifies possibilities for change in service delivery in England, UK

摘要

Aims and objectives: To clarify by consensus the professional and patient views of expected treatment outcomes for chronic obstructive pulmonary disease and to compare the similarities and differences and identify the potential for adjusting service delivery. Background: Chronic obstructive pulmonary disease is an under-researched topic necessary to illuminate health planning, and patient partnership needs in the UK clinical screening is low priority for this condition. Government policy expects that service users are involved in planning services for their condition, but few opportunities exist for this process. Design: A feasibility study in two phases conducted three service user focus groups and one specialist professional group to provide statements of expected treatment outcomes from chronic obstructive pulmonary disease interventions. The statements then formed a further two-round Delphi structured survey to compare service users' and carers' views with those of specialist professionals to ascertain what differences could be developed in service delivery for people with chronic obstructive pulmonary disease. Methods: Three rounds of Delphi survey were administered. Round 1: Specialist professionals and patients with chronic obstructive pulmonary disease ranked statements using nominal group technique. A nine-point scale Delphi consensus study used the statements in two further rounds. Results: Twenty-four of 54 professionals contacted, and 52 of 152 patients and carers completed Delphi rounds 2 and 3. Consensus was found within and between both groups. The greatest difference was where professionals sought government targets and did not realise patient expectations, which were constrained by policy disincentives. The greatest agreement was for accurate record keeping and the need for revised chronic obstructive pulmonary disease services. Conclusions: Patients consider that services should support them to retain their independence and enable their adaptation to the condition. Relevance to clinical practice: Health professionals aim to provide patient focused care based on need. This helps improve outcomes of interventions. Patients are willing and able if supported to increase independence and maintain self-help.