title: Sputum issues as defined by patients with cystic fibrosis: a qualitative investigation.
abstract: OBJECTIVE
  Patients with cystic fibrosis (CF) are asked to provide a sputum sample at clinic to test for potentially harmful pathogens. However, some appear to struggle with this request. Research into the difficulties experienced by these patients is lacking. This study set out to explore this issue in depth, using a qualitative research approach.
  
  
  METHODS
  Semi-structured interviews were conducted with 18 patients identified as having difficulties with sputum by the physiotherapists involved in their care. Framework analysis was applied to collected data.
  
  
  RESULTS
  An overarching concept derived from the interview material was a concern about sputum coming to be a defining feature of identity. This was reflected in the following four themes: (1) being seen as dirty because sputum is socially vilified as thus; (2) sputum exposing an invisible condition; (3) sputum acting as a reminder of having CF; (4) being seen as sputum producers by practitioners.
  
  
  CONCLUSIONS
  Patients' difficulties with expectorating sputum were multifaceted and included psychosocial and physical factors. Practitioners need to appreciate that for some people, a request for sputum can cause significant discomfort. Individualized interventions to assist these patients may prove helpful.
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, University Place, Oxford Road, Manchester M13 9PL, UK. stephanie.tierney@manchester.ac.uk
authors.forename: S
authors.initials: S
authors.lastname: Tierney
authors.forename: D
authors.initials: D
authors.lastname: Riley
authors.forename: A M
authors.initials: AM
authors.lastname: Jones
authors.forename: A K
authors.initials: AK
authors.lastname: Webb
authors.forename: M
authors.initials: M
authors.lastname: Horne
mesh_terms: D000328:Adult; D000739:Anecdotes as Topic; D001294:Attitude to Health; D003550:Cystic Fibrosis / Q000382:microbiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010353:Patient Education as Topic; D012649:Self Concept; D012752:Shame; D013048:Specimen Handling / Q000523:psychology*; D013183:Sputum; D011795:Surveys and Questionnaires; D055815:Young Adult