Personal Health Planning for Patients with COPD: Staff Perspectives from VA's Whole Health System

The need for person-centered care that promotes well-being and empowers patients is well-recognized. The Veterans Health Administration (VA), the largest U.S. healthcare system, is undergoing an enterprise-wide cultural transformation toward a Whole Health (WH) model of care that addresses this imperative. VA clinicians are asked to elicit what really matters to patients (Veterans) and help them set personal health goals, i.e., engage in WH personal health planning (WH-PHP). To inform ongoing implementation efforts, we sought to understand clinicians’ perspectives on WH-PHP for patients with chronic obstructive pulmonary disease (COPD), a widespread and debilitating condition. Between 10/2020-11/2021, we conducted 22 semi-structured interviews with clinicians in primary, pulmonary, mental health, and palliative care services at a large urban VA site. After coding transcripts for barriers and facilitators to implementing WH-PHP, we applied inductive thematic analysis to generate themes. Staff generally viewed WH-PHP as appropriate for patients with COPD, with nuances by service: Palliative and mental health clinicians questioned the “value added” of WH-PHP compared to their established practices. Their primary care counterparts worried about feasibility. Staff in pulmonary clinics had concerns about operationalizing WH-PHP in their work. These perspectives are nested in broader themes of interrelated individual and organizational factors we identified: (1) individual clinicians’ openness to practicing patient-centered, proactive care approaches, as influenced by prior education and professional socialization, (2) alignment of the service’s culture with the principles of patient-centered care and patient empowerment, and (3) availability of organizational support for implementing WH-PHP. The concept of WH-PHP was both attractive and ambiguous for clinicians. It is vital for patients with complex chronic conditions like COPD to be supported in pursuing personally meaningful health and wellbeing goals. For approaches like WH-PHP to become normalized, implementation efforts must account for the dynamic interplay of relevant individual and organizational factors.