Table 4

HCP discussion themes

ThemeDiscussion points
Changes in professional practiceThe intervention taught HCP’s to allow patients to talk more and explore their own answers/reasons. HCPs felt that in their profession they wanted to give answers/make suggestions straight away, but have learnt to allow silence and time for patients to explore answers/reasons for themselves.
Where this programme might fit in practiceHCP’s thought group-based COPD could be a good intervention at diagnosis—GP don’t have time to explain COPD, diagnosis, what to expect etc. SPACE could be that introduction as it covers healthy lifestyle, walking, exercising etc. At diagnosis, patients may also feel they are too good for PR, and may not be offered rehab until later on in the disease process.
Benefits of the group-based designLongevity of the groups allows ownership and responsibility to develop among patients. The time between sessions allows the group to come together, and patients looked forward to coming back. They used the time to work on their goals, join the gym/swimming sessions/walking groups, thus allowing longer time for support.
Group size and managementOften if the group size is too small it can be a struggle. A good size is approximately 10 people; bigger groups tend to be more respectful than smaller groups and as they require more management it seems easier to keep track of time. It can be tricky to manage patients with such a wide range of MRC grade 1–5, compared with PR when all patients have a limitation of some sort. However, this improved with time and HCP’s felt that they learnt how to manage the diversity of patients’ expectations in the groups.
  • SPACE could be used as part of tailor made/personalised medicine style approach where it is a part of a suite of services offered, and the clinician and patient decide together, the best option.

  • The training day was really useful, and vital to delivering the sessions well and using the right techniques such as MI.

  • In the future it could be delivered by practice nurses who are respiratory specialists. Need to ensure they are happy managing groups.

  • COPD, chronic obstructive pulmonary disease; GP, general practice; HCP, healthcare professional; PR, pulmonary rehabilitation; SPACE, Self-management Programme of Activity, Coping and Education.