Exploring the Patient Experience with Noninvasive Ventilation: A Human-Centered Design Analysis to Inform Planning for Better Tolerance

Overview

Journal Chronic Obstr Pulm Dis

Date 2022 Jan 12

PMID 35018753

Authors

Jill L McCormick

Taylar A Clark

Christopher M Shea

Dean R Hess

Peter K Lindenauer

Nicholas S Hill

Crystal E Allen

MaryJo S Farmer

Ashley M Hughes

Jay S Steingrub

Mihaela S Stefan

Affiliations

Soon will be listed here.

Abstract

Background: This study brings a human-centered design (HCD) perspective to understanding the patient experience when using noninvasive ventilation (NIV) with the goal of creating better strategies to improve NIV comfort and tolerance.

Methods: Using an HCD motivational approach, we created a semi-structured interview to uncover the patients' journey while being treated with NIV. We interviewed 16 patients with chronic obstructive pulmonary disease (COPD) treated with NIV while hospitalized. Patients' experiences were captured in a stepwise narrative creating a journey map as a framework describing the overall experience and highlighting the key processes, tensions, and flows. We broke the journey into phases, steps, emotions, and themes to get a clear picture of the overall experience levers for patients.

Results: The following themes promoted NIV tolerance: trust in the providers, the favorable impression of the facility and staff, understanding why the mask was needed, how NIV works and how long it will be needed, immediate relief of the threatening suffocating sensation, familiarity with similar treatments, use of meditation and mindfulness, and the realization that treatment was useful. The following themes deterred NIV tolerance: physical and psychological discomfort with the mask, impaired control, feeling of loss of control, and being misinformed.

Conclusions: Understanding the reality of patients with COPD treated with NIV will help refine strategies that can improve their experience and tolerance with NIV. Future research should test ideas with the best potential and generate prototypes and design iterations to be tested with patients.

Citing Articles

Psychological symptoms and health-related quality of life in intubated and non-intubated intensive care survivors: A multicentre, prospective observational cohort study.

Rai S, Neeman T, Brown R, Sundararajan K, Rajamani A, Miu M Crit Care Resusc. 2024; 26(1):8-15.

PMID: 38690186 PMC: 11056421. DOI: 10.1016/j.ccrj.2023.10.011.

Nursing Interventions for Client and Family Training in the Proper Use of Noninvasive Ventilation in the Transition from Hospital to Community: A Scoping Review.

Fernando J, Marcal M, Ferreira O, Oliveira C, Pedreira L, Baixinho C Healthcare (Basel). 2024; 12(5).

PMID: 38470656 PMC: 10930648. DOI: 10.3390/healthcare12050545.

Understanding Experiences of Caregivers of Spouses With Dementia During Caregiver Health Care Emergencies.

Daddato A, Gleason K, Dollar B, McPhail T, Kraus C, Boxer R Gerontologist. 2024; 64(7).

PMID: 38205833 PMC: 11194629. DOI: 10.1093/geront/gnad165.

Acceptance and adherence to non-invasive positive pressure ventilation in people with chronic obstructive pulmonary disease: a grounded theory study.

Volpato E, Banfi P, Pagnini F Front Psychol. 2023; 14:1134718.

PMID: 37599749 PMC: 10435845. DOI: 10.3389/fpsyg.2023.1134718.

Editorial: The psychological challenges of respiratory disease.

Volpato E, Banfi P, Verkleij M Front Psychol. 2023; 14:1213963.

PMID: 37292508 PMC: 10245553. DOI: 10.3389/fpsyg.2023.1213963.

References

Greenhalgh T, Jackson C, Shaw S, Janamian T . Achieving Research Impact Through Co-creation in Community-Based Health Services: Literature Review and Case Study. Milbank Q. 2016; 94(2):392-429. PMC: 4911728. DOI: 10.1111/1468-0009.12197. View

Lindenauer P, Dharmarajan K, Qin L, Lin Z, Gershon A, Krumholz H . Risk Trajectories of Readmission and Death in the First Year after Hospitalization for Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2017; 197(8):1009-1017. PMC: 5909167. DOI: 10.1164/rccm.201709-1852OC. View

Christensen H, Titlestad I, Huniche L . Development of non-invasive ventilation treatment practice for patients with chronic obstructive pulmonary disease:Results from a participatory research project. SAGE Open Med. 2017; 5:2050312117739785. PMC: 5682580. DOI: 10.1177/2050312117739785. View

Harte R, Glynn L, Rodriguez-Molinero A, Baker P, Scharf T, Quinlan L . A Human-Centered Design Methodology to Enhance the Usability, Human Factors, and User Experience of Connected Health Systems: A Three-Phase Methodology. JMIR Hum Factors. 2017; 4(1):e8. PMC: 5374275. DOI: 10.2196/humanfactors.5443. View

Roberts A . Understanding the principles of non-invasive positive pressure ventilation. Nurs Stand. 2021; 36(8):61-66. DOI: 10.7748/ns.2021.e11750. View

Smith T, Davidson P, Jenkins C, Ingham J . Life behind the mask: the patient experience of NIV. Lancet Respir Med. 2014; 3(1):8-10. DOI: 10.1016/S2213-2600(14)70267-X. View

Antonelli M, Conti G, Moro M, Esquinas A, Gonzalez-Diaz G, Confalonieri M . Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study. Intensive Care Med. 2002; 27(11):1718-28. DOI: 10.1007/s00134-001-1114-4. View

Ucgun I, Metintas M, Moral H, Alatas F, Yildirim H, Erginel S . Predictors of hospital outcome and intubation in COPD patients admitted to the respiratory ICU for acute hypercapnic respiratory failure. Respir Med. 2005; 100(1):66-74. DOI: 10.1016/j.rmed.2005.04.005. View

May S, Li J . Burden of chronic obstructive pulmonary disease: healthcare costs and beyond. Allergy Asthma Proc. 2015; 36(1):4-10. PMC: 5554331. DOI: 10.2500/aap.2015.36.3812. View

10.

Bhattacharyya O, Mossman K, Gustafsson L, Schneider E . Using Human-Centered Design to Build a Digital Health Advisor for Patients With Complex Needs: Persona and Prototype Development. J Med Internet Res. 2019; 21(5):e10318. PMC: 6532339. DOI: 10.2196/10318. View

11.

Demoule A, Girou E, Richard J, Taille S, Brochard L . Benefits and risks of success or failure of noninvasive ventilation. Intensive Care Med. 2006; 32(11):1756-65. DOI: 10.1007/s00134-006-0324-1. View

12.

Hedsund C, Linde Ankjaergaard K, Rasmussen D, Schwaner S, Andreassen H, Hansen E . NIV for acute respiratory failure in COPD: high in-hospital mortality is determined by patient selection. Eur Clin Respir J. 2019; 6(1):1571332. PMC: 6352931. DOI: 10.1080/20018525.2019.1571332. View

13.

Teixeira C, Rosa R, Sganzerla D, Sanchez E, Robinson C, Dietrich C . The Burden of Mental Illness Among Survivors of Critical Care-Risk Factors and Impact on Quality of Life: A Multicenter Prospective Cohort Study. Chest. 2021; 160(1):157-164. DOI: 10.1016/j.chest.2021.02.034. View

14.

Lightowler J, Wedzicha J, Elliott M, Ram F . Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ. 2003; 326(7382):185. PMC: 140272. DOI: 10.1136/bmj.326.7382.185. View

15.

Henninger M, McMullen C, Firemark A, Naleway A, Henrikson N, Turcotte J . User-Centered Design for Developing Interventions to Improve Clinician Recommendation of Human Papillomavirus Vaccination. Perm J. 2017; 21:16-191. PMC: 5593511. DOI: 10.7812/TPP/16-191. View

16.

Keenan S, Sinuff T, Cook D, Hill N . Which patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive-pressure ventilation? A systematic review of the literature. Ann Intern Med. 2003; 138(11):861-70. DOI: 10.7326/0003-4819-138-11-200306030-00007. View

17.

Messika J, Martin Y, Maquigneau N, Puechberty C, Henry-Lagarrigue M, Stoclin A . A musical intervention for respiratory comfort during noninvasive ventilation in the ICU. Eur Respir J. 2018; 53(1). DOI: 10.1183/13993003.01873-2018. View

18.

Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A . Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1995; 333(13):817-22. DOI: 10.1056/NEJM199509283331301. View

19.

Iosifyan M, Schmidt M, Hurbault A, Mayaux J, Delafosse C, Mishenko M . "I had the feeling that I was trapped": a bedside qualitative study of cognitive and affective attitudes toward noninvasive ventilation in patients with acute respiratory failure. Ann Intensive Care. 2019; 9(1):134. PMC: 6888797. DOI: 10.1186/s13613-019-0608-6. View

20.

Lemoignan J, Ells C . Amyotrophic lateral sclerosis and assisted ventilation: how patients decide. Palliat Support Care. 2010; 8(2):207-13. DOI: 10.1017/S1478951510000027. View