Title:	‘I’m fine’: exploring patient and carer assertions of status in advanced COPD and clinical implications for primary care
Project Description:	Expressing need is not always comfortable, desirable or considered legitimate by patients or their informal carers. A wide literature exists in medical sociology on the way individuals assert they are not sick and have no additional needs. We also know that in mental health settings patients who have substantial need but who nonetheless assert “I’m fine” to clinicians are at greater risk of treatment non-participation and their carers are also at risk of depression. To date these findings have not been explored in patients with physical health conditions or their carers. Initial analysis of data from the Living with Breathlessness Study (LWB), a mixed-method population-based multiple-perspective longitudinal study of patients and carers living with advanced COPD found that some patients and carers asserted they were “fine”, and not in need of support, despite clear evidence to the contrary. The proposed study seeks to explore the presence and role of these assertions for patients with advanced COPD and their carers, together with the impact this may have on their health, quality of life, relationship with their carer, service use and implications for clinical practice. The analysis will consist of: (1) further analysis of existing LWB transcripts to identify patient/carer assertions of “I’m fine” and to explore discourses within this sub-group; (2) identification of any associations between the presence of these assertions and clinically-relevant variables (e.g. reported service use, anxiety, depression, carer strain and carer distress) using appropriate statistical techniques; (3) identification of the implications for clinical practice via focus groups with primary care professionals. Better understanding the processes and implications of assertions of status will support future work on interventions to support patients and carers to better engage in the management of their condition.
Project organisation
Start date:	1st April 2017
End date:	31st March 2018
Contact person:	Mrs Carole Gardener
Contact Details:	Primary Care Unit Institute of Public Health University Forvie Site, Robinson Way Cambridge Cambs CB2 0SR UK Telephone: tba Fax: 01223 762515 E-mail: acg68@medschl.cam.ac.uk
Collaborative:	Dr Robbie Duschinsky (Primary Care Unit, Cambridge) Dr Morag Farquhar (University of East Anglia), Dr Gail Ewing (Centre for Family Research, Cambridge)
Funding information
Funding Organisation:	NIHR School for Primary Care Research
Funding Reference:	SPCR Funding Round 13
Funding Amount:	£24,420
Further Information, References and Publications