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Breakout 3.4 How to support the psychological needs of patients with COPD - Karen Heslop
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Breakout 3.4 How to support the psychological needs of patients with COPD - Karen Heslop

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Breakout 3.4 How to support the psychological needs of patients with COPD - Karen Heslop …

Breakout 3.4 How to support the psychological needs of patients with COPD - Karen Heslop
Respiratory Nurse Consultant/NIHR Clinical Academic Research Fellow
RVI Newcastle upon Tyne
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme

Published in: Health & Medicine

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  • 1. How to support the psychological needs of patients with COPD Karen Heslop MSc PGD in CBT BSc (Hons) Respiratory Nurse Consultant/NIHR Clinical Academic Research Fellow RVI Newcastle upon Tyne The Newcastle upon Tyne Hospital NHS Trust Introduction Umbrella term for chronic bronchitis and emphysema Affects over 3 million people in UK 30,000 deaths per year Costly (£1 billion on health care costs) Morbidity and suffering – patients and families 1
  • 2. Burden of COPD “When I can’t get my breath I think I am going to die” “I thought it was my last breath” “I can walk about 5 yards. Sometimes I just sit & cry…you get depressed… anyone would”. “In the past I had a gun at home during the amnesty I handed it in. If I still had it, I would have considered shooting myself as I get very depressed”Copyright K Heslop 18/02/2013 Psychological Difficulties in COPD  Higher rates of anxiety symptoms than those with cancer, heart failure or other medical conditions  Poorer survival  Health care utilization  Longer hospitalisation  Persistent smoking  Increased symptoms  Poorer physical and social functioning  Excessive use of medication (Ng, 2007)  Decline rehabilitation (Angle & Baum, 1997) 18/02/2013 2
  • 3. Anxiety & Panic in COPD  38 % Anxiety symptoms (NICE, 2010)  60% in Newcastle  Higher than with cancer, heart failure or other medical conditions  Catastrophic thoughts & impending danger.  Often unrecognised and untreated.  Mistaken from worsening COPD.  Significant predictor of the frequency of hospital admissions for acute exacerbations of COPD (Yohannes, 2000).Copyright K Heslop 18/02/2013 Depression  Absence of positive affect (loss of interest & enjoyment in ordinary things & experiences) & low mood  2-3 times more common in patients with chronic illnesses such as COPD  40% of patients.  Chronic physical health can cause and exacerbate depression  Patients tend to present with physical symptoms e.g. pain  Attention shifts to physical health problem & depression may be overlooked  Only a minority of patients discuss psychological problems (9% WHO, 1995)  Treatment helps improve quality of life and life expectancy (NICE 2009) 18/02/2013 3
  • 4. Treatment of Anxiety & Depression (NICE, 2011, 2009) Specialist review High intensity psychological interventions Combined treatments Referral if needed Low intensity psychological interventions Combined treatments (moderate) Referral if needed Screening, Assessment, support, psycho-education, active monitoring, physical exercise programme , peer support, referral if needed Treatment of anxiety & depression Self help – written information based on CBT principles e.g. NTW Mental Health Trust leaflets on Anxiety & Panic attacks Exercise Pulmonary rehabilitation CBT Pharmacological treatment if moderate to severe More research 4
  • 5. What is Cognitive Behaviour Therapy?  A psychological intervention - usually short term  Concentrates on the current difficulties  Problem and solution focused  Techniques directed at developing a shared understanding of problem  It’s about change  Not suitable for everyone Assessing What’s Happening Environment/Trigger Physical Behaviour Thoughts FeelingsPast experience - assumptions, attitudes, past learning 18/02/2013 5
  • 6. Techniques Case Study  68 Year old Male  Severe COPD  Ex –smoker  Previous coal miner  Very anxious  Main difficulties SOB & panic attacks  Declined pulmonary rehabilitation  Very supportive family  BAI 63 BDI 10Copyright K Heslop 18/02/2013 6
  • 7. Hot Cross Bun Situation Activity or thoughts Physical SOB +++, Sweating, heart races Thoughts Behaviour I’m going to die This is my last breath Avoids activity if pos Sits down Turns on FanShouts for wife for support Emotions Frightened Guilty Anxious (BAI 63)Copyright K Heslop Depressed (BDI 10) 18/02/2013 Treatment  Education re COPD/panic attacks/depression  Strategies :–  planning & pacing activities  distraction  breathing control  activity diary  problem solving  Follow up by telephone in 4 weeks!Copyright K Heslop 18/02/2013 7
  • 8. Outcome  BAI 0 / BDI 0  Never felt better  Breathing better  Plans things  Doing more physical activity & going out more  Feels more positive  Learnt a lot in last 4 weeks  No relapse 3 years later PhD Research Study Anxiety &Thoughts Breathless Panic Frightening Depression Reduced Respiratory Anxiety /Panic Anxiety Activity Depression Cycle TrainingHospital Admissions Quality of Life The Newcastle upon Tyne Karen Heslop 21/9/2010 Hospital NHS Foundation Trust 8
  • 9. Thank You 9