Emotional-distress-based Integrated Care Programme in Patients With Stable COPD

Reach: Total number of patients who take up the programme

Percentage of patients approached who take up the programme

Time frame: Four months

Reach: Percentage of patients who take part in at least one outpatient intervention

Number of interventions per patient and number of patients with termination of the programme before Week 13 is documented by the advanced practice nursing team

Time frame: Four months

Reach: Reasons for participating in the programme (facilitators and barriers)

Patients who decline the intervention are asked by the study nurse for their reasons (barriers). The reasons for taking up the programme (facilitators) will be qualitatively investigated in interviews. A semi-structured interview guide will be used.

Time frame: Four months

Reach: Reasons for ending (prematurely or on schedule) the programme (facilitators and barriers)

The reasons for ending (prematurely or on schedule) the programme will be qualitatively investigated in interviews. A semi-structured interview guide will be used

Time frame: Four months

Potential effectiveness: Change in depression

Quantitative: Depression will be screened with the Hospital Anxiety and Depression Scale (\*HADS\*). The concept is measured with seven 4-point rating scales, ranging from 0 to 3. The sum score, ranging from 0 to 21, will be calculated. Higher scores mean worse outcomes. Differences between MZP1 and MZP2 will be calculated per subscale. Qualitative: A semi-structured interview guide will be used, based on the quantitative results.

Time frame: Study duration per patient is three months with two measurement points. Baseline measurements will be applied in the first month (week 0-4). Second measurement will take place in month four (week 14-17).

Potential effectiveness: Change in anxiety

Quantitative: Anxiety will be screened with the Hospital Anxiety and Depression Scale (\*HADS\*). The concept is measured with seven 4-point rating scales, ranging from 0 to 3. The sum score, ranging from 0 to 21, will be calculated. Higher scores mean worse outcomes. Differences between MZP1 and MZP2 will be calculated per subscale. Qualitative: A semi-structured interview guide will be used, based on the quantitative results.

Time frame: Study duration per patient is three months with two measurement points. Baseline measurements will be applied in the first month (week 0-4). Second measurement will take place in month four (week 14-17).

Potential effectiveness: Change in health-related quality of life (*QoL*)

Quantitative: Health-related quality of life will be assessed with the Chronic Respiratory Questionnaire (\*CRQ\*), following the defined procedure of the developers. The self-administered questionnaire version with standardised dyspnoea questions (\*SAS\*) will be used. The questionnaire was developed for patients with chronic airflow limitations and comprises 20 items, which assess four domains: 1) dyspnea, 2) fatigue, 3) emotional function, and 4) mastery. The scoring scale ranges from 1 (extreme) to 7 (not at all), and will be assessed with a recall period of the past two weeks. A subscore for each domain (sum of items / number of items) will be calculated. The CRQ-SAS is available in German. It has demonstrated high sensitivity in the evaluation of a rehabilitation programme. Differences between baseline measurement and second measurement will be calculated per subscore. Qualitative: A semi-structured interview guide will be used, based on the quantitative results.

Time frame: Study duration per patient is three months with two measurement points. Baseline measurements will be applied in the first month (week 0-4). Second measurement will take place in month four (week 14-17).

Potential effectiveness: Patient satisfaction with programme

Quantitative: The questionnaire on the quality of nursing care counselling (\*ANP-BQ\*) is used to assess patient satisfaction. This instrument includes, for example, a question to assess the satisfaction of care provided by the ANP on an NRS 1-10. Qualitative: A semi-structured interview guide will be used, based on the quantitative results.

Time frame: Study duration per patient is three months with two measurement points. Baseline measurements will be applied in the first month (week 0-4). Second measurement will take place in month four (week 14-17).

Potential effectiveness: Number of moderate exacerbations within 3 months

Quantitative The number of moderate exacerbations during the previous three months are assessed at weeks 14-17. For this purpose, moderate exacerbations are defined as an acute (more than normal day-to-day variation) worsening of respiratory symptoms (breathlessness, sputum and / or coughing) that are treated with systemic antibiotics and / or corticosteroids (systemic = oral or intravenous). Qualitative A semi-structured interview guide will be used based on the quantitative results.

Time frame: Study duration per patient is three months, with two measurement points. Baseline measurements will be applied in the first month (week 0-4). Second, measurement will take place in month four (week 14-17).

Potential effectiveness: Number of severe exacerbations within 3 months

Quantitative: The number of severe exacerbations during the previous three months are assessed at weeks 14-17. For this purpose, severe exacerbations are defined as acute (more than normal day-to-day variation) worsening of respiratory symptoms (breathlessness, sputum and/or coughing) that result in hospitalisation or emergency room visit. Qualitative: A semi-structured interview guide will be used, based on the quantitative results.

Time frame: Study duration per patient is three months with two measurement points. Baseline measurements will be applied in the first month (week 0-4). Second measurement will take place in month four (week 14-17).

Potential effectiveness: Rehospitalisation at day 90

Quantitative The number of COPD-related rehospitalisations after 3 months is assessed by medical chart review. Qualitative In the case of rehospitalisation, a one-to-one interview and medical chart review will be performed to assess reasons for rehospitalisation.

Time frame: Study duration per patient is three months, with two measurement points. Baseline measurements will be applied in the first month (week 0-4). Second, measurement will take place in month four (week 14-17).

Potential effectiveness: Change in health behaviour smoking- current status

Quantitative Smoking behaviour will be assessed by using the questionnaire from the WHO. It assesses the current status of smoking (yes / no). Qualitative A semi-structured interview guide will be used based on the quantitative results.

Time frame: Study duration per patient is three months, with two measurement points. Baseline measurements will be applied in the first month (week 0-4). Second, measurement will take place in month four (week 14-17).

Potential effectiveness: Change in health behaviour smoking - ex- smoker

Quantitative Smoking behaviour will be assessed by using the questionnaire from the WHO. If an ex-smoker, it assesses date of smoking cessation (year). Qualitative A semi-structured interview guide will be used based on the quantitative results.

Time frame: Study duration per patient is three months, with two measurement points. Baseline measurements will be applied in the first month (week 0-4). Second, measurement will take place in month four (week 14-17).

Potential effectiveness: Change in health behaviour smoking -smoker

Quantitative Smoking behaviour will be assessed by using the questionnaire from the WHO. If a smoker, it assesses the substance and the number per day. Qualitative A semi-structured interview guide will be used based on the quantitative results.

Time frame: Study duration per patient is three months with two measurement points. Baseline measurements will be applied in the first month (week 0-4). Second measurement will take place in month four (week 14-17).

Potential effectiveness: Change in health behaviour nutrition - body weight

Quantitative Current body weight (kg) will be assessed. Qualitative A semi-structured interview guide will be used based on the quantitative results.

Time frame: Study duration per patient is three months with two measurement points. Baseline measurements will be applied in the first month (week 0-4). Second measurement will take place in month four (week 14-17).

Potential effectiveness: Change in health behaviour nutrition - body height

Quantitative Current body height (m) will be assessed. Qualitative A semi-structured interview guide will be used based on the quantitative results.

Time frame: Study duration per patient is three months with two measurement points. Baseline measurements will be applied in the first month (week 0-4). Second measurement will take place in month four (week 14-17).

Potential effectiveness: Change in health behaviour nutrition - BMI

Quantitative: Current body mass index (\*BMI\*) will be calculated according to the WHO recommendations (kg/m²). Qualitative: A semi-structured interview guide will be used, based on the quantitative results.

Time frame: Study duration per patient is three months with two measurement points. Baseline measurements will be applied in the first month (week 0-4). Second measurement will take place in month four (week 14-17).

Potential effectiveness: Change in health behaviour nutrition - NRS

Quantitative: The current nutritional risk screening (\*NRS\*) will be assessed during hospitalisation. Three and more points means a worse outcome. Qualitative: A semi-structured interview guide will be used, based on the quantitative results.

Time frame: Study duration per patient is three months with two measurement points. Baseline measurements will be applied in the first month (week 0-4). Second measurement will take place in month four (week 14-17).

Potential effectiveness: Change in health behaviour physical activity - C-PPAC

Quantitative: Self-report by patient, based on the first two items of the clinical version of PROactive Physical Activity in COPD instrument (\*C-PPAC\*). The items measure the amount of activity over the last 7 days, with a range from 0-4. Higher scores mean better outcomes. Qualitative: A semi-structured interview guide will be used based on the quantitative results:

Time frame: Study duration per patient is three months with two measurement points. Baseline measurements will be applied in the first month (week 0-4). Second measurement will take place in month four (week 14-17).

Potential effectiveness: Change in health behaviour physical activity - Pulmonary rehabilitation

Quantitative The use of pulmonary rehabilitation (\*PR\*) /outpatient physiotherapy is recorded. Qualitative A semi-structured interview guide will be used based on the quantitative results.

Time frame: Study duration per patient is three months with two measurement points. Baseline measurements will be applied in the first month (week 0-4). Second measurement will take place in month four (week 14-17).

Potential effectiveness: Change in health behaviour inhalation adherence

Quantitative: Adherence to inhalation will be assessed. The items were derived from the Zurich Assessment of Therapy Adherence CF (\*ZATA-CF\*) and adapted slightly. Patients are asked how often they needed to inhale the medication per day, and how often they had skipped an inhalation in the past seven days. Higher scores mean worse outcomes. Qualitative: A semi-structured interview guide will be used, based on the quantitative results.

Time frame: Study duration per patient is three months with two measurement points. Baseline measurements will be applied in the first month (week 0-4). Second measurement will take place in month four (week 14-17).

Potential effectiveness: Change in health behaviour action plan

Quantitative: Availability of a prescription for an action plan (with/without self-medication) and adherence of patients to the action plan will be assessed. Qualitative: A semi-structured interview guide will be used, based on the quantitative results.

Time frame: Study duration per patient is three months with two measurement points. Baseline measurements will be applied in the first month (week 0-4). Second measurement will take place in month four (week 14-17).

Potential effectiveness: Change in health behaviour oxygen use

Quantitative: Availability of an oxygen prescription, and the patient's compliance with the prescription, are assessed. Qualitative: A semi-structured interview guide will be used, based on the quantitative results.

Time frame: Study duration per patient is three months with two measurement points. Baseline measurements will be applied in the first month (week 0-4). Second measurement will take place in month four (week 14-17).

Implementation: Percent of programme components carried out according to the intervention manual

Quantitative: Completed intervention components per patient were documented by the ANP team. Necessary, but not or not fully completed parts of the intervention are also documented. Qualitative: To understand reasons for performing, omitting or modifying components of the programme, structured small group interviews will be conducted with HCP's involved in intervention delivery. The interview guide will be based on the results of the document analysis.

Time frame: Six months

Implementation: Acceptability of the programme

Quantitative: The German translation of the Acceptability of Intervention Measure (\*AIM\*) scale will be used to assess the healthcare professional's perspective. The scale contains four items; all are rated on a 5-point response scale (1 = completely disagree, 5 = completely agree). The investigators added a sixth option, "no response" (0 points). Qualitative: To understand reasons for the results, structured small group interviews will be conducted with involved HCPs. The interview guide will be based on the results of the questionnaires.

Time frame: Six months

Implementation: Appropriateness of the programme

Quantitative: The German translation of the Intervention Appropriateness Measure (\*IAM\*) scale will be used to assess the healthcare professional's perspective. The scale contains four items; all are rated on a 5-point response scale (1 = completely disagree, 5 = completely agree). The investigators added a sixth option, "no response" (0 points). Qualitative: To understand reasons for the results, structured small group interviews will be conducted with involved HCPs. The interview guide will be based on the results of the questionnaires.

Time frame: Six months

Implementation: Feasibility of the programme

Quantitative The German translation of the Feasibility of Intervention Measure (\*FIM\*) scale will be used to assess the healthcare professional's perspective. The scale contains four items; all are rated on a 5-point response scale (1 = completely disagree, 5 = completely agree). The investigators added a sixth option "no response" (0 points). Qualitative To understand reasons for the results structured small group interviews will be conducted with involved HCPs. The interview guide will be based on the results of the questionnaires.

Time frame: Six months