Meet Bob. At 72 years old, there isn’t much he hasn’t been through. Although he quit smoking 10 years ago, Bob was diagnosed with COPD when he was just 65 years old. Last year, when his oxygen saturation levels dropped below 87% at rest, he was prescribed continuous oxygen therapy. Because Bob lives alone, his son who lives a few hours away hired Angie, a 27 year-old caregiver to stay with him during the day. Upon arrival this morning, Angie finds Bob sitting in his easy chair with a confused look on his face. When she asks him if he’s ok, his answer doesn’t make much sense. As she looks about the room, she notices the oxygen concentrator is still in the “on” position, but the nasal cannula is lying in a heap atop the coffee table. When Angie checks Bob’s oxygen saturation, she finds it’s only 78%. As soon as Angie tries to replace the oxygen cannula, Bob becomes angry and tells her to leave him alone. It’s only after Angie calls Bob’s son that he finally agrees to use his supplemental oxygen again.
Seemingly, caregivers all across the country are trying to solve the oxygen-adherence dilemma. Why do some patients balk at using supplemental oxygen? More importantly, how can you convince a patient or loved one to use supplemental oxygen if they don’t really want to?
Risk Factors for Non-Compliance
It’s a proven fact that long-term oxygen therapy (LTOT) worn for at least 15 hours a day improves survival in some patients with severe COPD. In fact, using oxygen continuously is far superior to using it intermittently or only at night. If oxygen is so beneficial, why do some patients fail to use it as prescribed? Researchers have been trying to solve this puzzle for years and have found that many patients:
- lack a clear understanding of the benefits of using supplemental oxygen.
- are reluctant to wear a nasal cannula or be tied down to an oxygen delivery source.
- are concerned about addiction and/or bothersome side effects.
- continue to feel poorly, in spite of using supplemental oxygen.
- misunderstand their prescription.
- are embarrassed to be seen in public in light of the social stigma associated with smoking-related lung diseases.
How to Improve Oxygen Adherence
The benefits of LTOT have been well-documented. Not only does it increase survival when used for more than 15 hours a day as mentioned previously, but it improves depression, cognition, quality of life and exercise capacity.
If someone you care for is reluctant to use their supplemental oxygen as prescribed, the following interventions have been suggested in clinical trials as a means to help promote oxygen adherence:
- Encourage regular follow-up visits with the oxygen-prescribing physician – According to research published in Pulmonary Medicine, patients tend to be more compliant with oxygen therapy when their prescription is associated with a respiratory physician; not a family doctor. Researchers also found that 36% of all patients using LTOT are not receiving prescriptions that reflect current guidelines as measured by the Nocturnal Oxygen Therapy Trial and the British Medical Research Council. Respiratory physicians are more likely to write an effective oxygen prescription that conforms to present standards.
- Advocate for doctor-patient communication – The absence of doctor-patient communication at regular intervals impacts a patient’s adherence to LTOT. Regular follow-up and sincere communication between doctor and patient has a positive impact on oxygen adherence.
- Ask for clear and precise instructions on use – Misunderstanding an oxygen prescription is one of the most common reasons that patients don’t comply with oxygen therapy. When patients are given instructions on how to use supplemental oxygen, they should repeat them back to their prescribing physician to ensure that they understand the prescription.
- Seek continued education regarding potential benefits – Studies suggest that the majority of patients have only a single conversation with their prescribing doctors at the time they’re given their initial prescription. Adherence to LTOT is closely related, in part, to continued education regarding the potential long-term health benefits.
- Endorse family training and social support – Family involvement is crucial if oxygen adherence is to be maintained. Furthermore, a social support system has also been found to increase compliance. Most oxygen supply companies have knowledgeable staff on hand to provide training to willing and able family members. Additionally, hospitals often provide social support groups for patients with chronic illnesses.
- Suggest switching to a more convenient oxygen source like the Inogen One – Patients who are tied down to a single oxygen source are less likely to adhere to oxygen therapy. Thankfully, the portability of the Inogen One allows patients to be ambulatory and independent.
Author: Deborah Leader RN, BSN, PHN
1Katsenos, Stamatis and Constantopoulos, Stavros, H. Long-Term Oxygen Therapy in COPD: Factors Affecting and Ways of Improving Patient Compliance. Pulmonary Medicine. 2011.