Taking a chance: the experience of lung volume reduction procedures for chronic obstructive pulmonary disease

Abstract

Objectives: Lung Volume Reduction Surgery and Endo-Bronchial ValveTM insertion have expanded the therapeutic choices for chronic obstructive pulmonary disease (COPD). Controversy over efficacy, costs and risks limits access to these therapies. There are no published findings to guide our understanding of the patient’s experience of surgery. The aim of this study is to understand the experience of palliative surgery for COPD. Methods: Merleau-Ponty’s philosophy provided a framework for this Heideggerian phenomenological inquiry. Fifty-eight semi-structured interviews were conducted with 15 patients undergoing lung volume reduction procedures and 14 family members. Results: Patients and families felt they had no option but to ‘take a chance’ on surgery. Interventions frequently led to regaining lost tasks or easier completion of existing tasks. Where patients did not perceive an increase in things they could ‘do’, surgery allowed some to reclaim their sense of self. Regardless of the outcome, most did not regret their decision for surgery. Discussion: Meanings of surgery are not always tied to the visible, objective measurements of outsiders but may relate to regaining of self. Despite the concerns of some clinicians, patients and families are more likely to accept the risk of morbidity and mortality from surgery than has previously been realized.