Patient and carer perspectives to explain the negative results of the TANDEM (Tailored intervention for ANxiety and DEpression Management in COPD) trial

Clinical Research Results Abstract IntroductionChronic obstructive pulmonary disease (COPD) is commonly associated with long term psychological conditions which can affect self-management and quality of life. The TANDEM trial evaluated a cognitive behavioural approach intervention, delivered prior to pulmonary rehabilitation (PR) by respiratory healthcare professionals to COPD patients with symptoms of anxiety and/or depression. The intervention failed to improve anxiety, depression or uptake /retention of PR in a large trial. We present qualitative data on patient and carer perspectives to help understand these results. Method23 individual interviews were conducted, 19 with patients with COPD and four with carers (12 telephone interviews due to pandemic). Interviews, using a theoretically informed topic guide, were audio-recorded, transcribed verbatim and analysed thematically. ResultsFour emergent themes (with subthemes) were identified: (1) Complex lives “The thing that gets me down is I've got Parkinson's as well, which is making walking difficult at the moment. … it takes a lot of effort. So I get out of breath as well.” (2) TANDEM experience “I hated the homework bit. … was almost like sometimes it was very patronising what [facilitator] was telling me … or getting me to write about or whatever. So she actually changed the approach ….” (3) TANDEM impact “I've got lazy. I said I was going to keep them (exercises) up but…. I think the incentive's gone” (4) Role of TANDEM in COPD “… ideally right at the beginning. Because it was a lot to get your head around. And I was in therapy when I was diagnosed, so I could've done with it back then. Definitely.”DiscussionOur results suggest alternative interventions with a more holistic – and sustained - focus on the complexity surrounding patients with COPD, i.e. other comorbidities, their independent effects or interaction with COPD, and the social environment are required. Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest This study is funded by the National Institute for Health Research Health Technology Assessment programme (project number 13/146/02). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. References and Clinical Trial Registry Information Trial registration ISRCTN59537391 (https://www.isrctn.com/ISRCTN59537391)