Living with severe chronic obstructive pulmonary disease (COPD): perceptions of patients and their carers. An interpretative phenomenological analysis.

BACKGROUND: A study designed to explore the experiences of patients with severe chronic obstructive pulmonary disease (COPD) and their carers, particularly with regard to ongoing and palliative care needs. METHODS: The participants were nine men and one woman with severe COPD and the carers of eight of the men, in East Devon, UK. Semi-structured interviews were undertaken, transcribed and analysed using interpretative phenomenological analysis (IPA). RESULTS: The emergent themes were of losses, adaptation, relationships with health professionals and effect on carer. Losses reflected the loss of personal liberty and dignity and of previous expectations of the future. Adaptation included strategies to cope with the effects of the disease. Relationships related to both positive and negative aspects of contact with health professionals. There was appreciation for continuity of care and reassurance. The effect on the carer was evident particularly as they had to take on multiple roles. They also experienced some of the same losses as the patient and appeared enmeshed with the illness. CONCLUSIONS: This study confirmed the inexorable decline in activities of daily life and social isolation for patients with severe COPD. Adaptive strategies were common and some positive aspects were identified. Support from the primary health care team was appreciated. The strain on carers was very apparent. The concept of a more structured sharing of information and a surveillance role mediated by health care professionals known to the patient and carer would be a pragmatic approach to improving care.

Endometrial sampling in general practice.

Unexpected vaginal bleeding is a common problem in general medical practice and likely to increase as more women use hormone replacement therapies (HRT). This study looks at the successful introduction of a technique for endometrial sampling into general practice, allowing earlier diagnosis of endometrial cancer and reassurance for women without serious pathology.

Teenagers and risk-taking: pregnancy and smoking.

Teenage pregnancy and teenage smoking are both areas of concern in the United Kingdom. This study found that girls who had had a teenage pregnancy were more likely to smoke than those who had not conceived as teenagers.

PIP: Teenage pregnancy and smoking are areas of concern in the UK. All women under age 20 years on December 31, 1995, attending a group practice in Honiton who had had a pregnancy during their teen years participated in a study to explore the relationship between cigarette smoking among female adolescents and their likelihood to become pregnant as teenagers. This group of women was compared with an age/sex/general practitioner matched control group of young women who had not experienced pregnancy while a teenager. Smoking history could be found for 36 of the 37 (97%) women in the teen pregnancy group and 33 (89%) of the women in the control group. 22 of the 36 (61%) women in the teen pregnancy group with known smoking histories had smoked cigarettes, compared to 7 of the 33 (21%) women in the control group, a statistically significant difference at the P0.01 level. These findings suggest that teenagers who become pregnant are more likely to have smoked at some stage than are those who do not conceive as teenagers.

Teenagers' use of emergency contraception in a general practice.

British teenagers who become pregnant commonly express ignorance about emergency contraception. A case-note survey was conducted in a general practice serving about 14,200 people in a Devon market town. Of the 373 registered girls aged 15-19 years, 59 (16%) had consulted for emergency contraception, 19 of them more than once. The oral method (Yuzpe regimen) was prescribed eighty times and 2 girls became pregnant. 4 of the 59 girls who used emergency contraception had subsequent unwanted pregnancies. A consultation for emergency contraception presents an opportunity to discuss more reliable and acceptable methods of contraception.

Like mother, like daughter: a general practice study of maternal influences on teenage pregnancy.

This study confirmed the hypothesis that pregnant teenagers in the 1990s are more likely to have a mother who had a teenage pregnancy than non-pregnant teenagers. It also found that the daughters of teenage mothers are more likely to continue their own pregnancies.

PIP: General practice records were studied to identify differences between pregnant and nonpregnant teenagers in relation to their mothers' experiences. 37 females aged 13-19 years registered with the Honiton Group Practice who had had at least one pregnancy by January 1, 1996, were studied in detail. An equal number of nonpregnant controls also participated in the study. For 31 of the 37 girls in the study group and 34 of the 37 in the control group it was possible to establish whether their mother had had a teenage pregnancy. Half of the pregnant teenagers had a mother who had also had a teenage conception compared with 25% of the girls in the control group. These findings therefore confirm the hypothesis that pregnant teenagers in the 1990s are more likely to have a mother who had a teenage pregnancy than nonpregnant teens. The study also found that the daughters of teenage mothers are more likely to continue their own pregnancies.