title: Integrating psychological screening into reviews of patients with COPD.
abstract: BACKGROUND
  People with chronic obstructive pulmonary disease (COPD) have a high prevalence of anxiety and depression, which can have an impact on their symptoms and the way they manage their condition. Intervention that takes psychological distress into account may lead to better outcomes than simple advice-giving.
  
  
  OBJECTIVE
  To explore the feasibility of integrating psychological screening and intervention into nurse-led reviews of patients with COPD.
  
  
  METHODS
  Nurses were given training on a pathway developed for patients with COPD. This included screening for depression and anxiety and assessing their severity; providing self-management education by means of a motivational approach; and offering pulmonary rehabilitation.
  
  
  RESULTS
  The nurses' level of confidence increased following training. Patients were accepting of the screening process and felt more able and motivated to manage their condition after the intervention. Eleven of the 35 patients that took part in the study period had evidence of anxiety and/or depression. Out of a total of 16 patients eligible for pulmonary rehabilitation, 12 agreed to referral. Of these, three patients were seen by their GP, one was started on antidepressants, and one was referred to the psychology service.
  
  
  CONCLUSIONS
  Training practice nurses to screen for depression and anxiety, and to offer self-management education using a motivational interviewing approach, increased the reported capability and motivation of patients with COPD to manage their condition. It may also improve the uptake of pulmonary rehabilitation. Use of this pathway does not place a burden on other care providers or greatly increase prescribing costs.
authors.affiliation: Education Fellow, UCLPartners, Honorary Senior Lecturer, University College London, and Visiting Fellow, University of Northampton.
authors.forename: Sheila
authors.initials: S
authors.lastname: Hardy
authors.forename: David
authors.initials: D
authors.lastname: Smart
authors.forename: Mike
authors.initials: M
authors.lastname: Scanlan
authors.forename: Stephen
authors.initials: S
authors.lastname: Rogers
mesh_terms: D005240:Feasibility Studies; D006801:Humans; D011581:Psychological Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology*
keywords: Anxiety; Chronic obstructive pulmonary disease; Depression; Motivational interviewing; Nurse's role; Self-care