SELF-DETERMINED SENSE OF HOPELESSNESS IN COPD – A GROUNDED THEORY STUDY

Self-determined sense of hopelessness in COPD – a Grounded Theory study Introduction: Living with Chronic Obstructive Pulmonary Disease (COPD) is a struggling experience, with a negative impact both on the physical and psychological well-being of those affected. Aim: The main aim was to develop a theoretical account of the perception and expectation patterns of COPD patients, considering their severity levels. Methods: This Grounded Theory study, conducted at the U.O.C. Cardio Respiratory Rehabilitation Unit of the IRCCS Fondazione Don Carlo Gnocchi in Milan (Italy), involved 20 participants with COPD who underwent semi-structured face-to-face interviews about their experience and expectations of the disease. Interviews were audio-recorded, transcribed, and analyzed using a grounded theory approach. Moreover, a visual tool exploring their symptoms and the Pictorial Representation of Illness and Self-measure (PRISM) were administered. Clinical data have been also considered. Analysis was conducted through NVivo (version 12). Results: Theoretical saturation of substantive codes was achieved with 20 interviews [Males=13 (65%)]. The participants’ mean age and the forced expiratory volume in 1 second were 68,18 (SD=7,17) years and 66 (SD=6,14) percent of predicted, respectively. The core category was “hopelessness”. COPD was perceived as a serious threat to one’s daily activities, and interests. The most described symptoms were shortness of breath, sleep disturbances, and fatigue, resulting in depressive symptoms often linked to avoidance and a reduction in the motivation to undertake more challenging activities. In general, patients demonstrated some difficulties to project themselves into the future; negative illness expectations, linked to the sense of responsibility due to cigarette smoking, emerged in most cases, especially in patients with severe COPD. Feeling supported and hopeful about the effectiveness of treatment seems to have a positive influence on patients’ coping styles. Discussion: This study confirmed how COPD limits patients' quality of life, increasing their general rejection of life. Investigating perceptions of their condition and focusing on their expectations might be useful to introduce personalized therapeutic interventions, where patients are the real experts of their disease.