{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T14:58:40Z","timestamp":1790521120665,"version":"4.1.0"},"reference-count":24,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015610","name":"Windermere Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015610","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Hosp Palliat Care"],"abstract":"<jats:sec>\n                    <jats:title>Background\/Aim<\/jats:title>\n                    <jats:p>A growing body of evidence exists detailing the benefits of singing for lung health programs in improving participants\u2019 breathlessness and quality of life. However, the pandemic prompted a shift to online delivery, and there is limited understanding of how this mode of delivery impacts participants\u2019 interactions and engagement. This study aimed to explore how social connections and group interactions unfold within an online singing for respiratory illness national clinical trial, the SINFONIA trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>An ethnographic study including observations of 18 clinical trial participants with advanced chronic obstructive pulmonary disease and interstitial lung disease across 20 weekly sessions. Observations and quotes from participants were recorded using Spradley\u2019s field-note list, and thematic data analysis was used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Group members\u2019 interactions evolved over time with three themes emerging: (1) adaptation and community building; (2) evolution of group dynamics; and (3) dynamics of leadership and influence. As the singing program progressed, participants formed warm social connections that transcended geographical limitations. The program fostered a supportive environment where participants could share experiences of their chronic disease, appearing to promote resilience within the evolving group dynamics. Throughout the trial, the singing leaders\u2019 relaxed approaches to the classes and clinical backgrounds shaped the group dynamics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Evolving relationships and group dynamics were observed within the singing program for respiratory illness, offering insights to inform delivery approaches and enhance participant engagement. Future work should explore how best to manage these dynamics and support leaders in balancing guidance with taking on organisational and leadership roles themselves.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10499091261491309","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T14:33:16Z","timestamp":1790260396000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ethnography of Singing for Breathing in COPD and ILD: Understanding Group Dynamics and Experiences"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8220-1900","authenticated-orcid":false,"given":"Lena","family":"Ly","sequence":"first","affiliation":[{"name":"University of Melbourne"},{"name":"Monash University"},{"name":"Respiratory Medicine, The Alfred Hospital"},{"name":"Prahran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Smallwood","sequence":"additional","affiliation":[{"name":"University of Melbourne"},{"name":"Monash University"},{"name":"Respiratory Medicine, The Alfred Hospital"},{"name":"Prahran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Hudson","sequence":"additional","affiliation":[{"name":"University of Melbourne"},{"name":"St Vincent\u2019s Hospital"},{"name":"End of Life Research, Vrije University Brussels"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Goh","sequence":"additional","affiliation":[{"name":"University of Melbourne"},{"name":"Respiratory and Sleep, Austin Health"},{"name":"Institute for Breathing and Sleep"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3312-0645","authenticated-orcid":false,"given":"Jennifer","family":"Philip","sequence":"additional","affiliation":[{"name":"University of Melbourne"},{"name":"St Vincent\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"issue":"1","key":"e_1_3_5_2_2","doi-asserted-by":"crossref","first-page":"e001291","DOI":"10.1136\/bmjresp-2022-001291","article-title":"Incidence and prevalence of interstitial lung diseases worldwide: a systematic literature review","volume":"10","author":"Gupta RS","year":"2023","unstructured":"Gupta RS, Koteci A, Morgan A, George PM, Quint JK. Incidence and prevalence of interstitial lung diseases worldwide: a systematic literature review. BMJ Open Respir Res. 2023;10(1):e001291.","journal-title":"BMJ Open Respir Res"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.46598"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1183\/20734735.0200-2019"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-018-0371-8"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00102-2017"},{"key":"e_1_3_5_7_2","first-page":"1","volume-title":"The Changing Role of Opioids for Symptom Management in People with Advanced Lung Disease","author":"Pascoe A","year":"2025","unstructured":"Pascoe A, Smallwood N. The Changing Role of Opioids for Symptom Management in People with Advanced Lung Disease. Taylor & Francis; 2025:1-3."},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00205-2025"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/npjpcrm.2016.80"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-018-2063-5"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rppneu.2014.02.009"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjresp-2024-002365"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.65328\/2025.ntkx4667"},{"issue":"1","key":"e_1_3_5_14_2","article-title":"Moving singing for lung health online in response to COVID-19: experience from a randomised controlled trial","volume":"7","author":"Philip KE","year":"2020","unstructured":"Philip KE, Lewis A, Jeffery E, et al. Moving singing for lung health online in response to COVID-19: experience from a randomised controlled trial. BMJ Open Respir Res. 2020;7(1):e000737.","journal-title":"BMJ Open Respir Res"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-022-02133-3"},{"key":"e_1_3_5_16_2","unstructured":"Royal Brompton & Harefield NHS Foundation Trust. Singing for breathing vocal exercises. https:\/\/www.themusicalbreath.com\/2021\/05\/13\/singing-for-breathing-cd-downloads\/"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.4324\/9780203864722"},{"key":"e_1_3_5_18_2","first-page":"1","article-title":"Online ethnography","volume":"24","author":"Hart T.","year":"2017","unstructured":"Hart T. Online ethnography. IECRM. 2017;24:1-8.","journal-title":"IECRM"},{"key":"e_1_3_5_19_2","volume-title":"Participant Observation","author":"Spradley JP","year":"1980","unstructured":"Spradley JP. Participant Observation. 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