COPD Action Plans: Gaps in Development Methods, Content, and Format

Purpose: COPD action plans (APs) are integral to self-management and recommended across clinical practice guidelines, but primary care provider and patient usage remain low. Given that uptake is influenced by content, format, and development methods, we sought to collect a broad sample of existing COPD APs and to analyze these characteristics. Materials and Methods: We collected English language COPD APs from: 1) an internet search; 2) international COPD guidelines; 3) pulmonary/COPD organizations and experts; and 4) published randomized controlled trials (RCTs) evaluating COPD APs. For each AP, we described background information, development methods and any available evaluation data. We used guideline-based and inductively-derived criteria for AP content analysis. For format analysis, we applied recognized evidence-based formatting standards for printed educational material. We also calculated the Flesch-Kincaid readability scores. Results: We identified 63 unique COPD APs from seven countries. Information on the development methods was available in only seven (11%) APs, and only one included patients in development. 4/58 (7%) APs identified from sources other than RCTs had been formally evaluated (all as part of larger complex interventions). In AP content, we found inconsistency in definitions for the action point requiring treatment, in treatment instructions (eg medication options, doses, and duration), and in lifestyle/behavior change cues. Formatting across APs was also variable, and APs met a mean of only 5.4 ± 1.2 out of 8 core formatting principles for printed education material design. The average Flesch-Kincaid grade level was 6.5 ± 1.6. Conclusion: COPD APs are recommended across guidelines but are seldom implemented. Our novel analysis of internationally available COPD APs reveals that there are several intrinsic factors related to their development, evaluation, content, and format that may be contributing to this care gap. A uniform user preference-based COPD AP with expert consensus on content, and with usability/format optimization should be developed and evaluated.