P40 Shared decision making in Pulmonary rehabilitation: a qualitative needs assessment
Bibliographic record
Abstract
Introduction and Objectives Pulmonary rehabilitation (PR) is an evidence-based treatment for patients with COPD. However, the national audit reveals significant under-referral and uptake to the programme,1 which will likely continue during the Coronavirus Disease 2019 (COVID-19) pandemic because of restrictions to PR delivery. At University Hospitals of Leicester NHS Trust (UHL) a choice of centre-based and home-based programmes exist to support individual patient needs but are not routinely offered at referral. To support referral and uptake to PR, exploring the barriers and facilitators to the current approach and a new menu-based approach to PR is warranted. Methods Individual, semi-structured interviews were conducted with respiratory healthcare professionals (rHCPs) who refer patients with COPD to PR and COPD patients who were PR naive and had received a referral. Interviews were audio-recorded, transcribed verbatim and analysed using The Enhanced Critical Incident Technique.2 Categories were generated to reflect helping, hindering and wish list items, then validated and reviewed by a collaborating and independent expert. Results 22 participants were recruited (rHCPs=14; COPD patients=8). 276 critical incidents generated 108 hindering, 108 helping and 60 wish list categories. The identified mediators of PR engagement were: Understanding PR/menu-based programmes, Perceived ability to access PR, A desire to accept PR, A referring practitioner’s support of PR, and Understanding COPD (see figure 1). Conclusion The menu-based approach offers increased opportunity for patients to engage in PR particularly during the COVID-19 pandemic. However, its poor identity limits its feasibility and acceptability. Building the identity of COPD, PR/menu of programmes, further integrating PR in COPD care and developing tools to illicit patient-centred discussions is recommended. The findings support the development of a shared decision making intervention to facilitate patient-centred discussions regarding the menu of PR programmes available at UHL. References Steiner M, Holzhauer-Barrie J, Lowe D, Searle L, Skipper E, Welham SRC ( 2015). National COPD Audit Programme: Pulmonary Rehabilitation: Time to breathe better. Butterfield LD, Borgen, WA, Maglio, A-ST, & Amundson NE. ( 2009). Using the Enhanced Critical Incident Technique in Counselling Psychology Research. In Canadian Journal of Counselling/Revue canadienne de counseling (Vol. 43).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.041 | 0.042 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.010 | 0.009 |
| Scholarly communication | 0.006 | 0.006 |
| Open science | 0.003 | 0.012 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".