Nurse-Led/Involved Home-Based Interventions for Older Adults With Chronic Obstructive Pulmonary Disease (COPD): A Mixed-Methods Systematic Review.

Aims: To determine the effectiveness of nurse-led/involved home-based interventions for older people with COPD and to explore the experiences of older people and nurses with the interventions.

Design: A mixed-methods systematic review following the JBI methodology for mixed-methods systematic reviews.

Data Sources: The search included relevant and peer-reviewed studies published from January 2010 to December 2023 in CINAHL, MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, EMBASE, JBI, EMCARE and ProQuest.

Review Methods: English-language reports of nurse-led/involved home-based interventions for people with COPD were included based on authors' consensus. Three reviewers performed independent quality appraisal using JBI tools. A convergent segregated approach was used for data synthesis and integration.

Results: Seven interventions were identified in two mixed-methods, two qualitative, two quasi-experimental studies, and one secondary analysis from a randomised control trial. The effectiveness of the interventions was measured with various outcomes and was effective to some extent, with reduced hospitalisation, hospitalisation days, hospitalisation cost and all-paid claims. However, the outcomes were not statistically significant, and the effectiveness was inconclusive. While patients appreciated support and resources, some perceived them as a double-edged sword.

Conclusions: Patients preferred more holistic interventions over extended periods. The inconclusive findings and limitations warrant further research with larger sample sizes and comparable measurement tools and outcomes.

Impact: This is the first mixed-methods systematic review on the effectiveness of home interventions for people with COPD with a clear definition of 'nurse-led'. Nurses felt highly valued by patients and other health professionals; however, they reported a lack of support from management. The lack of interventions led by nurses challenges them to lead, deliver and evaluate what matters to people with COPD.

Reporting Method: This systematic review was reported in accordance with the Referred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Patient Or Public Contribution: Not applicable.