Cognitive and Emotional Responses to COPD Exacerbations and Patterns of Care Seeking.

Locke ER, Thomas RM, Simpson TL, Fortney JC, Battaglia C, Trivedi RB, Gylys-Colwell J, Swenson ER, Edelman JD, Fan VS. Cognitive and Emotional Responses to COPD Exacerbations and Patterns of Care Seeking. Annals of the American Thoracic Society. 2023 Nov 15.

Related HSR&D Project(s)

• IIR 14-060 – Understanding Patient Management of COPD Exacerbations

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Abstract:

RATIONALE: Cognitive and emotional responses associated with care seeking for COPD exacerbations are not well understood. OBJECTIVES: We sought to define care seeking profiles based on whether and when US Veterans seek care for COPD exacerbations and compare cognitive and emotional responses to exacerbation symptoms across the profiles. METHODS: This study analyzes data from a 1-year prospective observational cohort study of individuals with COPD. Cognitive and emotional responses to worsening symptoms were measured with the Response to Symptoms Questionnaire (RSQ), adapted for COPD. Seeking care was defined as contacting or visiting a health care provider or going to the emergency department. Participants were categorized into four care seeking profiles based on the greatest delay in care seeking for exacerbations when care was sought: 0-3 days (early), 4-7 days (short-delay), > 7 days (long-delay), or never sought care for any exacerbation. The proportion of exacerbations where participants reported cognitive and emotional responses was estimated for each care seeking profile stratified by the timing of when care was sought. RESULTS: There were 1,052 exacerbations among 350 participants with RSQ responses. Participants were predominantly male (96%) and mean age was 69.3 ± 7.2. For the 409 (39%) exacerbations where care was sought, the median delay was 3 days. Those who sought care had significantly more severe COPD (FEV1, mMRC dyspnea scale) than those who never sought care. Regardless of degree of delay to seeking care at one exacerbation, participants consistently reported experiencing serious symptoms if they sought care, compared to events where participants did not seek care (e.g., among early care-seekers, when care was sought: 36%; when care was not sought: 25%). Similar findings were seen in participants'' assessment of importance of getting care (e.g., among early care-seekers, when care was sought: 90%; when care was not sought: 52%) and their assessment of anxiety about the symptoms (e.g., among early care-seekers, when care was sought: 33%; when care was not sought: 17%). CONCLUSIONS: Delaying or not seeking care for COPD exacerbations was common. Regardless of care seeking profile, cognitive and emotional responses to symptoms when care was sought differed from responses when care was not sought. Emotional and cognitive response to COPD exacerbations should be considered when developing individualized strategies to encourage seeking care for exacerbations. CLINICAL TRIAL REGISTRATION: NCT02725294 Primary Source of Funding: This work was supported by VA Health Services Research and Development (HSRandD) IIR-14-060 from the United States Department of Veterans Affairs Health Services Research and Development Program. Principal Investigator: Vincent S. Fan, MD, MPH.