Applying a cognitive behavioural approach in COPD: views of respiratory professionals.

Rationale: COPD is a long-term condition with comorbidities such as anxiety and depression that are associated with poorer health outcomes. The TANDEM (Tailored intervention for Anxiety and Depression Management in COPD) trial investigated whether a psychological intervention, delivered by respiratory healthcare professionals ("facilitators") using a tailored cognitive behavioural approach, would reduce anxiety and/or depression and improve pulmonary rehabilitation attendance in patients with advanced COPD. The intervention did not reduce anxiety or depression or improve pulmonary rehabilitation attendance. As part of the trial process evaluation, we explored facilitators' communication with patients, professional role and identity, and perspectives on implementation. Methods: Qualitative interviews with 14 facilitators (nurses, physiotherapists and occupational therapists) who were trained to deliver the cognitive behavioural approach sessions. Results: Facilitators recognised the need for psychological care and were positive about the training, practice and clinical supervision. The intervention was viewed as helpful for some, but not all, patients. Comorbidities and social and personal challenges affected patient engagement in identifying and addressing COPD-related anxiety and depression. There was scepticism about incorporating a cognitive behavioural approach intervention such as TANDEM into routine healthcare due to resource constraints. Conclusions: Respiratory healthcare professionals valued being trained and supported to deliver a tailored intervention using a cognitive behavioural approach to patients with COPD. The complexity of comorbidity and patients' social context presented barriers to engagement. The intervention was viewed as unlikely to be delivered as part of routine care. Greater focus on patient engagement in the context of multimorbidity and psychosocial complexity is recommended.