Table 2

Practical issues

Theme 2: practical
Tool designFocus on issues relevant to the patient and carer. A guide to consultation.‘… this is a prompt to say have you asked about this area of a patient's wellbeing, because these are the sorts of things that people forget, they don't ask systematically about psychological symptoms, they don't ask systematically about activities of daily living, or spiritual concerns …’. (Expert group, P1)
TrainingRecognition of training needed to implement this tool.‘I think it's a training need perhaps for the doctors doing this and knowing these things are probably relevant for a range of sub-specialties in respiratory medicine …’. (Focus group, P2).‘I would like us to discuss what type of skills would be needed or what type of resources you may need to ask as part of putting this into practice’. (Expert group, P6)
Barriers with potential solutions
Structure and resourcesChallenge of current team dynamics and hospital logistics.‘… I don't know, is it [the NAT:ILD] something you do when it's triggered by a hospital admission, or is it something that's triggered by your unscheduled (…) is it something that's done routinely at new patients every six months, I don't know, when would it?!’ (Focus group, P2)
Lack of human resources, focus on clinic activity (eg, 15 min per consultation)‘… but it would mean significant modification of the way we do our consultation’. (Focus group, P4)
Comparative lack of key members of the multidisciplinary team‘I think, you know, every chronic disease clinic should have a psychologist attached …’. (Focus group, P1)
‘… but also economic stratification. So the ones that are severe are probably going to have greater needs for medical resources, as well as the social care …’. (Focus group, P1)
Cultural competenceCulture change needed for routine enquiry about psychosocial and spiritual well-being‘… in the TB clinic actually with lots of different backgrounds, and there, there are people from all over the world who often have much stronger faith beliefs than we do UK …’. (Focus group, P4)‘… I mean from a trainee point of view, this would mean integrating these patient wellbeing questions into our consultation …would mean significant modification of our consultation models …’. (Expert group, P4)
TrainingImportance of awareness of interstitial lung disease impact on patients’ and carers’ lives but poorly equipped to address non-medical issues. ‘So we should maybe learn, look at some of the other specialties and see how they've done it’. (Expert group, P3)
With training and practice in the use of the tool could complete a holistic framework (including spiritual needs) but is likely to increase consultation time.‘… initially we find ourselves asking a lot of questions which are probably not relevant (…) you probably could avoid some of those bits and probably integrate lessons like this … even then it's difficult in a fifteen minute consultation …’. (Expert group, P1)