A study of attitudes, beliefs and organisational barriers related to safe emergency oxygen therapy for patients with COPD (chronic obstructive pulmonary disease) in clinical practice and research

Background: Patients can be harmed by receiving too much or too little oxygen but there is ongoing disagreement about the use of oxygen in medical emergencies. For this reason, we have studied the attitudes and beliefs of lay people and health care workers about oxygen therapy and oxygen research. Methods: This was a mixed methods study (survey, telephone interviews and focus groups) involving patients with chronic obstructive pulmonary disease (COPD), members of the general public and health care professionals (HCPs). Results: 62 patients with COPD, 65 members of the public, 68 ambulance crew members, 22 doctors, 22 nurses and 10 hospital managers took part in this study. For five factual questions about oxygen therapy, the average score for correct answers was 28% for COPD patients, 33% for the general public and 75% for HCPs with little variation between doctors, nurses and ambulance crews. The HCPs had an average score of 66% for five more technical questions about oxygen therapy. They reported that specialised equipment was not always available to them and training in oxygen use could be improved. Questions about attitudes to oxygen therapy revealed that patients (79%) and members of the general public (68%) were more likely than HCPs (36%) to believe that oxygen was beneficial in most medical emergencies and less likely to have concerns that it might harm some people (35%, 25% and 68%). All groups had complex attitudes about research into oxygen use in medical emergencies. Many participants would not wish for themselves or their loved ones to have their oxygen therapy determined by a randomised protocol, especially if informed consent was not possible in an emergency situation. Conclusion: Although oxygen is the most commonly used drug in medical emergencies, we have found low levels of factual knowledge amongst COPD patients and the general public and many false beliefs about the potential benefits and harms of using oxygen. HCPs had a higher level of factual knowledge but exhibited a complex mix of attitudes and beliefs about oxygen use. All groups had complex attitudes towards research into emergency oxygen use which could make it difficult to conduct randomised trials of this important treatment.