title: Why Do Patients with COPD Decline Rehabilitation.
abstract: OBJECTIVE
  This paper aimed to suggest possible answers to the question: Why do patients with COPD decline pulmonary rehabilitation (PR)?
  
  
  METHODS
  The study is a metasynthesis inspired by Noblit of the existing qualitative research on the area. The data were collected during 2014. Six studies were found through a systematic literature search in relevant databases. In these six studies, 65 persons were identified as decliners of PR. Four themes were identified from these studies.
  
  
  RESULTS
  The themes identified were as follows: the referral process, transport problems, perception of health and other obligations or priorities. The problems with the referral of patients relate to different areas: the referring health professional's conviction and commitment, and the patients' understanding of the referral. It seems that various transport problems cause decline, for example long distance to the PR centre or the expenses of getting back and forth. Perceptions of health cause decline. Decliners feel too sick to join PR or do not identify themselves as a sick person, and do not want undertake the 'patient role'. Other obligations or priorities such as work, family obligations and vacations are prioritised on behalf of PR causing decline.
  
  
  CONCLUSIONS
  The studies included show patients' rational accounts and reflections on declining PR. The included studies tend to describe accounts for deselection of PR in relation to the preferences and beliefs of the patients rather than including the social and economic variables framing the behaviour and choices of the patients.
authors.affiliation: Department of Nursing, Metropolitan University College, Copenhagen, Denmark.
authors.forename: Helle
authors.initials: H
authors.lastname: Mathar
authors.affiliation: Department of Nursing, Metropolitan University College, Copenhagen, Denmark.
authors.forename: Pernille
authors.initials: P
authors.lastname: Fastholm
authors.affiliation: Department of Nursing, Metropolitan University College, Copenhagen, Denmark.
authors.forename: Ida Rode
authors.initials: IR
authors.lastname: Hansen
authors.affiliation: Department of Nursing, Metropolitan University College, Copenhagen, Denmark.
authors.forename: Niels Sandholm
authors.initials: NS
authors.lastname: Larsen
mesh_terms: D006801:Humans; D010342:Patient Acceptance of Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*
keywords: chronic obstructive pulmonary disease; decline; literature review/metasynthesis; other obligations; perception of health; pulmonary rehabilitation; referral process; transportation