Recruitment for psychological therapy in chronic obstructive pulmonary disease (COPD) What factors influence participation

Aims and Objectives This prospective study compared patients with COPD who participated in a randomised controlled trial (RCT) of cognitive behavioural therapy (CBT) delivered by respiratory nurses with those who were eligible but declined. Methods Patients with COPD attending out-patient respiratory clinics were screened for symptoms of anxiety using the Hospital Anxiety & Depression Score (HADS). Patients with HADS score ≥8 for anxiety were invited to participate in a RCT of CBT. Participants in the RCT were compared with those who were eligible but had declined participation in the study. Data including gender, age, COPD severity (as per NICE Criteria, 2010), anxiety and depression scores were analysed using Chi-Square tests and linear regression. Results In total data from 336 patients were analysed. 174 patients were recruited to the study compared to 162 patients were eligible but declined. There were no gender differences between those who participated and those who declined (Chi-Square = 2.015, DF = 1, p>0.1). Those recruited were on average 3 years younger (p 0.1). They were not more anxious (t = -0.57 p>0.5) but they were more depressed (t= -2.05 p<0.05). Conclusion There are recognised difficulties in recruiting patients with COPD for non-pharmacological treatments such as pulmonary rehabilitation. We have shown that younger patients and those who more depressed are more likely to agree to a study involving psychological treatment. Further analysis of why patients decline potentially beneficial treatments and novel strategies to engage them are needed.