title: Development of a self-treatment approach for patients with COPD and comorbidities: an ongoing learning process.
abstract: BACKGROUND
  Patient-initiated action plans are an important component of COPD self-management (SM) interventions. When integrated into SM interventions, these action plans have proven to be effective in reducing exacerbation severity, hospitalisations, and costs and in improving health status in patients with COPD without severe comorbidities. Because of overlap in symptoms, a self-treatment (ST) approach that focuses solely on traditional symptoms of COPD is inadequate for patients with COPD and comorbidities. The COPE-III SM intervention combines (I) patient-initiated action plans that are tailored to the individual's co-morbid disease(s), and (II) ongoing nurse support. In this paper we provide information regarding the integration of information from two previous COPD SM studies (COPE I and II) in the development of the current COPE-III ST approach.
  
  
  METHODS
  COPE-III ST materials include daily symptom diaries and action plans that take patient's common comorbidities [chronic heart failure (CHF), anxiety, depression, ischaemic heart disease (IHD), and diabetes] into account. The comorbid diary and action plans components were developed in collaboration with multiple disease-experts.
  
  
  RESULTS
  Previous SM studies have highlighted some essential topics that need to be considered when developing a SM or ST approach: 'when to initiate ST', 'how to optimize materials and safety', and 'how to achieve behavioural change'. In the COPE-III study, ST is initiated after a significant change in symptoms. This is consistent with the COPE-II approach and was implemented because disease symptoms are often present even when patients are stable. We have tried to ensure patient safety by providing an easily accessible case-manager to patients throughout their involvement in the study. Furthermore, a psychologist has ensured the use of behavioural change techniques throughout the intervention.
  
  
  CONCLUSIONS
  We should continue to learn from our experiences with SM interventions to further optimize future SM and ST interventions. The use of materials that are suitable for different levels of patient literacy and the training of health care providers are other points of improvement.
authors.affiliation: 1 Department of Respiratory Medicine, Southern Adelaide Local Health Network, South Australia, Australia ; 2 Flinders University, School of Medicine, Adelaide, South Australia, Australia ; 3 Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands ; 4 Southern Adelaide Local Health Network, South Australia, Australia ; 5 Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, South Australia, Australia ; 6 Department of Research Methodology, University of Twente, Measurement and Data Analysis, Enschede, the Netherlands.
authors.forename: Tanja W
authors.initials: TW
authors.lastname: Effing
authors.affiliation: 1 Department of Respiratory Medicine, Southern Adelaide Local Health Network, South Australia, Australia ; 2 Flinders University, School of Medicine, Adelaide, South Australia, Australia ; 3 Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands ; 4 Southern Adelaide Local Health Network, South Australia, Australia ; 5 Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, South Australia, Australia ; 6 Department of Research Methodology, University of Twente, Measurement and Data Analysis, Enschede, the Netherlands.
authors.forename: Anke
authors.initials: A
authors.lastname: Lenferink
authors.affiliation: 1 Department of Respiratory Medicine, Southern Adelaide Local Health Network, South Australia, Australia ; 2 Flinders University, School of Medicine, Adelaide, South Australia, Australia ; 3 Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands ; 4 Southern Adelaide Local Health Network, South Australia, Australia ; 5 Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, South Australia, Australia ; 6 Department of Research Methodology, University of Twente, Measurement and Data Analysis, Enschede, the Netherlands.
authors.forename: Julie
authors.initials: J
authors.lastname: Buckman
authors.affiliation: 1 Department of Respiratory Medicine, Southern Adelaide Local Health Network, South Australia, Australia ; 2 Flinders University, School of Medicine, Adelaide, South Australia, Australia ; 3 Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands ; 4 Southern Adelaide Local Health Network, South Australia, Australia ; 5 Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, South Australia, Australia ; 6 Department of Research Methodology, University of Twente, Measurement and Data Analysis, Enschede, the Netherlands.
authors.forename: Deborah
authors.initials: D
authors.lastname: Spicer
authors.affiliation: 1 Department of Respiratory Medicine, Southern Adelaide Local Health Network, South Australia, Australia ; 2 Flinders University, School of Medicine, Adelaide, South Australia, Australia ; 3 Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands ; 4 Southern Adelaide Local Health Network, South Australia, Australia ; 5 Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, South Australia, Australia ; 6 Department of Research Methodology, University of Twente, Measurement and Data Analysis, Enschede, the Netherlands.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Cafarella
authors.affiliation: 1 Department of Respiratory Medicine, Southern Adelaide Local Health Network, South Australia, Australia ; 2 Flinders University, School of Medicine, Adelaide, South Australia, Australia ; 3 Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands ; 4 Southern Adelaide Local Health Network, South Australia, Australia ; 5 Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, South Australia, Australia ; 6 Department of Research Methodology, University of Twente, Measurement and Data Analysis, Enschede, the Netherlands.
authors.forename: Morton G
authors.initials: MG
authors.lastname: Burt
authors.affiliation: 1 Department of Respiratory Medicine, Southern Adelaide Local Health Network, South Australia, Australia ; 2 Flinders University, School of Medicine, Adelaide, South Australia, Australia ; 3 Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands ; 4 Southern Adelaide Local Health Network, South Australia, Australia ; 5 Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, South Australia, Australia ; 6 Department of Research Methodology, University of Twente, Measurement and Data Analysis, Enschede, the Netherlands.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Bassett
authors.affiliation: 1 Department of Respiratory Medicine, Southern Adelaide Local Health Network, South Australia, Australia ; 2 Flinders University, School of Medicine, Adelaide, South Australia, Australia ; 3 Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands ; 4 Southern Adelaide Local Health Network, South Australia, Australia ; 5 Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, South Australia, Australia ; 6 Department of Research Methodology, University of Twente, Measurement and Data Analysis, Enschede, the Netherlands.
authors.forename: Clara
authors.initials: C
authors.lastname: van Ommeren
authors.affiliation: 1 Department of Respiratory Medicine, Southern Adelaide Local Health Network, South Australia, Australia ; 2 Flinders University, School of Medicine, Adelaide, South Australia, Australia ; 3 Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands ; 4 Southern Adelaide Local Health Network, South Australia, Australia ; 5 Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, South Australia, Australia ; 6 Department of Research Methodology, University of Twente, Measurement and Data Analysis, Enschede, the Netherlands.
authors.forename: Sally
authors.initials: S
authors.lastname: Anesbury
authors.affiliation: 1 Department of Respiratory Medicine, Southern Adelaide Local Health Network, South Australia, Australia ; 2 Flinders University, School of Medicine, Adelaide, South Australia, Australia ; 3 Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands ; 4 Southern Adelaide Local Health Network, South Australia, Australia ; 5 Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, South Australia, Australia ; 6 Department of Research Methodology, University of Twente, Measurement and Data Analysis, Enschede, the Netherlands.
authors.forename: Paul D L P M
authors.initials: PD
authors.lastname: van der Valk
authors.affiliation: 1 Department of Respiratory Medicine, Southern Adelaide Local Health Network, South Australia, Australia ; 2 Flinders University, School of Medicine, Adelaide, South Australia, Australia ; 3 Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands ; 4 Southern Adelaide Local Health Network, South Australia, Australia ; 5 Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, South Australia, Australia ; 6 Department of Research Methodology, University of Twente, Measurement and Data Analysis, Enschede, the Netherlands.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Frith
authors.affiliation: 1 Department of Respiratory Medicine, Southern Adelaide Local Health Network, South Australia, Australia ; 2 Flinders University, School of Medicine, Adelaide, South Australia, Australia ; 3 Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands ; 4 Southern Adelaide Local Health Network, South Australia, Australia ; 5 Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, South Australia, Australia ; 6 Department of Research Methodology, University of Twente, Measurement and Data Analysis, Enschede, the Netherlands.
authors.forename: Job
authors.initials: J
authors.lastname: van der Palen
keywords: Pulmonary disease; chronic obstructive; comorbidity; self-care