‘I’m fine’: exploring patient and carer assertions of status in advanced chronic obstructive pulmonary disease (COPD) and implications for primary care

BackgroundPatients can be reluctant to say that they need support, telling clinicians they are ‘fine’ despite having unmet needs. Research in mental health settings suggests patients who do this they are less likely to follow treatment plans, and their carers are at a risk of depression. To-date these findings have not been explored in patients with advancing physical health conditions, or their carers.AimTo explore the presence, role and impact of assertions of ‘I’m Fine’ in patients with advanced chronic obstructive pulmonary disease (COPD) and their carers.MethodCriteria based on Attachment Theory were used to identify ‘I’m Fine’ cases from the Living with Breathlessness Study (LwB) dataset of 235 patients and 115 carers. Quantitative analysis explored variables such as health service use between ‘I’m Fine’ and non ‘I’m Fine’ cases, whilst narrative analysis is being used to explore discourses within cases.Results21 patients and six carers asserted they were ‘fine’ despite unmet needs. Patients’ minimised disease impact and symptoms, avoided thinking about the future and used stoical language. Despite ‘I’m Fine’ cases being more likely to report no exacerbations and more likely to score less on the COPD Assessment Test (CAT), all wanted to see more of their GP. Carers focused on the needs of the patient whilst downplaying their own problems.ConclusionThe existence of a sub-group of patients with advanced COPD who assert that they are ‘fine’ may have implications for primary care. This will be explored in planned focus groups with clinicians.