Letter to the Editor
Perception of a lack of social support in patients with chronic obstructive pulmonary disease. A real problem. How can we face it?
Percepción de falta de apoyo social en pacientes con enfermedad pulmonar obstructiva crónica. Un problema real, ¿cómo podemos afrontarlo?
D. Díaz Pérez, L. Llanos Rodríguez, J.M. Figueira Gonçalves
Corresponding author
Pneumology and Thoracic Surgery Service, University Hospital Nuestra Señora de la Candelaria (HUNSC), Santa Cruz de Tenerife, Spain
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Cortés-Rodríguez, M. Alférez-Reyes, P. Castro, R. Casasola, F. Sánchez, A. Lozano" "autores" => array:6 [ 0 => array:2 [ "nombre" => "B." "apellidos" => "Cortés-Rodríguez" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Alférez-Reyes" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Castro" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Casasola" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Sánchez" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Lozano" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2603647919300223?idApp=UINPBA00004N" "url" => "/26036479/0000003400000003/v1_201906130629/S2603647919300223/v1_201906130629/es/main.assets" ] "itemAnterior" => array:17 [ "pii" => "S2603647919300272" "issn" => "26036479" "doi" => "10.1016/j.jhqr.2019.01.005" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "696" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "J Healthc Qual Res. 2019;34:154-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "HTML" => 2 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CARTA AL DIRECTOR</span>" "titulo" => "¿Otorga la nueva ley la autonomía deseada para nuestros pacientes?" 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"apellidos" => "González-Castro" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2603647919300272?idApp=UINPBA00004N" "url" => "/26036479/0000003400000003/v1_201906130629/S2603647919300272/v1_201906130629/es/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Perception of a lack of social support in patients with chronic obstructive pulmonary disease. A real problem. How can we face it?" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "155" "paginaFinal" => "156" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "D. Díaz Pérez, L. Llanos Rodríguez, J.M. Figueira Gonçalves" "autores" => array:3 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Díaz Pérez" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Llanos Rodríguez" ] 2 => array:4 [ "nombre" => "J.M." "apellidos" => "Figueira Gonçalves" "email" => array:1 [ 0 => "juanmarcofigueira@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Pneumology and Thoracic Surgery Service, University Hospital Nuestra Señora de la Candelaria (HUNSC), Santa Cruz de Tenerife, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Percepción de falta de apoyo social en pacientes con enfermedad pulmonar obstructiva crónica. Un problema real, ¿cómo podemos afrontarlo?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In contrast to cancer or dementia, chronic obstructive pulmonary disease (COPD) progresses in a much more complex way. Some authors suggest that the extent of the needs of patients with advanced chronic diseases reaches beyond the purely clinical and disease management aspects and must include multidimensional questions in their evaluation (functional, social, psychological, and ethical points).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Advanced disease, invalidating dyspnoea, and functional deficits limit the patients’ access to the outside world, like going out into the street and meet people, as they are not able to overcome the barriers of their homes (i.e. stairs, flats without a lift, etc.). The forced seclusion and social isolation inevitably form a handicap difficult to overcome. They restrict access to instrumental, leisure, and social life activities, which in turn lead to the occurrence of depressive states, anxiety or both.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">To evaluate the psychosocial situation in a cohort of patients with COPD, followed up at the Outpatient Clinics of Pneumology of the University Hospital Nuestra Señora de Candelaria (HUNSC), Santa Cruz de Tenerife, a descriptive observational study was conducted from January 2011 to December 2013. The Gijón as well as the Goldberg scale were applied. Out of a database of 308 COPD patients, 100 agreed to participate in the study. The patients’ mean age was 68<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.5. The majority (84%) were males; 18% were active smokers with a forced expiratory volume in the first second (FEV1) mean of the predicted 46%<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18 and a mean BODE index of 4. A total of 84% of the patients stated not to have any support from their social network (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), 42% had incomes below the inter-professional minimum salary, and 56% had some signs of depression.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The perception of lack of social support has harmful effects on health and leads to an increase in depressive symptoms, a decrease in physical activity and quality of sleep, an increase in tobacco consumption, and also to reduced social interactions when spending a long time in solitude. These conditions augment morbidity and mortality to a similar extent as other known factors, such as smoking, obesity, or hypertension.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3–5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">COPD goes beyond a purely pulmonary dysfunction,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> and the lack of social support reported by our COPD patients must be taken into account, as it can significantly affect patient management. Improving the follow up and handling during the care process for this group includes an adequate health education on the disease itself as well as putting emphasis on a correct treatment adherence and self care and should also consider the need for a family approach.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Informal caregivers (IC) provide technical and emotional support. We can find that patients supported by IC are less likely to smoke, seek emergency services less frequently, and adhere better to pharmacological treatment.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> Therefore, the role of IC is fundamental to a comprehensive framework of patient care and provides benefits to both the patient and the health system. However, we must take into account how the caregiver perceives the disease, as this could lead to a higher degree of dependence of the patient on their environment, so that health professionals should evaluate the role of the IC.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In a situation of poverty, the possibilities of receiving support are limited, given that the members of this support network are in a similar situation of precariousness and vulnerability. Thus, help would need to be sought outside said setting, e.g., in the health sector. However, it must be taken into account that the services provided throughout the territory are heterogeneous.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> Professional awareness of this “other reality” and its approach from a perspective that comprehends the patients’ daily life situation are essential to meet sometimes hidden and not sufficiently expressed needs. Adapting to this reality is key to alleviate symptomatology and its functional and psychological repercussion, which would allow persons with COPD to better cope and manage their situation more effectively.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">LISMI: Law on the Social Integration of the Disabled; FAS: health assistance for illness/old age.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Family situation</span><span class="elsevierStyleHsp" style=""></span>-Lives with the family without physical psychological dependence<span class="elsevierStyleHsp" style=""></span>-Lives with a partner of similar age<span class="elsevierStyleHsp" style=""></span>-Lives with the family and/or partner and exhibits some degree of dependence<span class="elsevierStyleHsp" style=""></span>-Lives alone with nearby living children<span class="elsevierStyleHsp" style=""></span>-Lives alone with children living far away or no children \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27701110 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Economic situation</span><span class="elsevierStyleHsp" style=""></span>-More than 1.5 times the minimum salary<span class="elsevierStyleHsp" style=""></span>-From 1.5 times the minimum salary to the minimum salary only<span class="elsevierStyleHsp" style=""></span>-From the minimum salary to the minimum contributory pension<span class="elsevierStyleHsp" style=""></span>-LISMI, FAS, or non-contributory pension<span class="elsevierStyleHsp" style=""></span>-No income or less than listed in point 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">212110239 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Housing</span><span class="elsevierStyleHsp" style=""></span>-Adequate for the needs<span class="elsevierStyleHsp" style=""></span>-Architectural Barriers in the dwelling or at the entrance<span class="elsevierStyleHsp" style=""></span>-Humidity, poor hygiene, inadequate equipment<span class="elsevierStyleHsp" style=""></span>-Missing lift, telephone<span class="elsevierStyleHsp" style=""></span>-Inadequate home (shanties, housing declared in ruins, lack of minimal equipment) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">883270 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Social relationships</span><span class="elsevierStyleHsp" style=""></span>-Social relationships<span class="elsevierStyleHsp" style=""></span>-Social relationships with family and neighbours only<span class="elsevierStyleHsp" style=""></span>-Social relationships with either family or neighbours<span class="elsevierStyleHsp" style=""></span>-Does not leave home, receives visits<span class="elsevierStyleHsp" style=""></span>-Does not leave home nor receive visits \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7110991 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Social network support</span><span class="elsevierStyleHsp" style=""></span>-With family and neighbourhood support<span class="elsevierStyleHsp" style=""></span>-Social volunteers, home help<span class="elsevierStyleHsp" style=""></span>-No support at all<span class="elsevierStyleHsp" style=""></span>-Pending admission to geriatric residence<span class="elsevierStyleHsp" style=""></span>-With permanent care \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1428400 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2056894.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Data obtained through the Gijón scale.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A model to guide patient and family care: based on nationally accepted principles and norms of practice" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.D. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 9 | 1 | 10 |
| 2024 September | 11 | 3 | 14 |
| 2024 August | 17 | 9 | 26 |
| 2024 July | 6 | 3 | 9 |
| 2024 June | 10 | 3 | 13 |
| 2024 May | 12 | 5 | 17 |
| 2024 April | 22 | 4 | 26 |
| 2024 March | 26 | 9 | 35 |
| 2024 February | 9 | 8 | 17 |
| 2024 January | 14 | 2 | 16 |
| 2023 December | 12 | 3 | 15 |
| 2023 November | 18 | 3 | 21 |
| 2023 October | 22 | 5 | 27 |
| 2023 September | 16 | 2 | 18 |
| 2023 August | 10 | 2 | 12 |
| 2023 July | 12 | 1 | 13 |
| 2023 June | 7 | 6 | 13 |
| 2023 May | 9 | 2 | 11 |
| 2023 April | 17 | 3 | 20 |
| 2023 March | 10 | 2 | 12 |
| 2023 February | 19 | 4 | 23 |
| 2023 January | 26 | 6 | 32 |
| 2022 December | 34 | 12 | 46 |
| 2022 November | 33 | 9 | 42 |
| 2022 October | 27 | 10 | 37 |
| 2022 September | 26 | 8 | 34 |
| 2022 August | 16 | 9 | 25 |
| 2022 July | 13 | 11 | 24 |
| 2022 June | 12 | 8 | 20 |
| 2022 May | 18 | 14 | 32 |
| 2022 April | 10 | 8 | 18 |
| 2022 March | 15 | 5 | 20 |
| 2022 February | 32 | 5 | 37 |
| 2022 January | 36 | 2 | 38 |
| 2021 December | 10 | 4 | 14 |
| 2021 November | 16 | 7 | 23 |
| 2021 October | 22 | 17 | 39 |
| 2021 September | 20 | 10 | 30 |
| 2021 August | 21 | 1 | 22 |
| 2021 July | 34 | 5 | 39 |
| 2021 June | 18 | 8 | 26 |
| 2021 May | 23 | 4 | 27 |
| 2020 September | 1 | 0 | 1 |
| 2019 August | 1 | 2 | 3 |
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