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Tinti S, Parati M, De Maria B, Urbano N, Sardo V, Falcone G, Terzoni S, Alberti A, Destrebecq A. Multi-Dimensional Dyspnea-Related Scales Validated in Individuals With Cardio-Respiratory and Cancer Diseases. A Systematic Review of Psychometric Properties. J Pain Symptom Manage 2022; 63:e46-e58. [PMID: 34358643 DOI: 10.1016/j.jpainsymman.2021.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT In order to examine the multi-dimensional nature of dyspnea and its impact on the activities of daily living (ADLs) in patients with cardio-respiratory and cancer diseases, validated measures are needed. OBJECTIVES Our aim was to identify all the multi-dimensional clinical scales assessing dyspnea and its impact on ADLs in patients with cardio-respiratory and cancer diseases, and to critically appraise their psychometric properties. METHODS Five databases were systematically searched up to July 2020. Eligible criteria were: the examination of at least one psychometric property, and the recruitment of adults with a cardio-respiratory or cancer disease in non-emergency settings. The characteristics and psychometric properties of the studies included were presented through a narrative synthesis. The methodological quality of the studies and evidence synthesis were rated using the "COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)" criteria. RESULTS Forty-three studies, for which eight assessment scales had been identified, were included in the review. At the time of the review, three multi-dimensional assessment scales were available for assessing dyspnea symptoms, and five multi-dimensional scales were available to examine the impact of dyspnea on ADLs. Although the use of these scales has rapidly grown, evidence of psychometric properties has been reported as limited in most of the scales. CONCLUSION Despite the potential of the identified scales, further studies are needed to strength evidence on the validity and reliability of the multi-dimensional dyspnea scales. Furthermore, more studies appraising the content validity and responsiveness of the scales are specifically recommended.
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Affiliation(s)
- Stefania Tinti
- Department of Biomedicine and Prevention (S.T.), University of Rome ''Tor Vergata'', Rome, Italy.
| | - Monica Parati
- Department of Electronics, Information and Bioengineering, Neuroengineering and Medical Robotics Laboratory (M.P.), Politecnico di Milano, Milan, Italy; IRCCS Istituti Clinici Scientifici Maugeri (M.P., B.D.M.), Milan, Italy
| | - Beatrice De Maria
- IRCCS Istituti Clinici Scientifici Maugeri (M.P., B.D.M.), Milan, Italy
| | - Nicla Urbano
- ASST-Rhodense (N.U.), Garbagnate Milanese, Milan, Italy
| | - Vivian Sardo
- ASST-Rhodense, Palliative Care and Pain Therapy Department (V.S., G.F.), Garbagnate Milanese, Milan, Italy
| | - Graziella Falcone
- ASST-Rhodense, Palliative Care and Pain Therapy Department (V.S., G.F.), Garbagnate Milanese, Milan, Italy
| | - Stefano Terzoni
- ASST-Santi Paolo e Carlo (S.T.), University of Milan, Milan, Italy
| | - Annalisa Alberti
- ASST-Rhodense Bachelor School of Nursing (A.A.), Rho, Milan, Italy
| | - Anne Destrebecq
- Department of Biomedical Sciences for Health (A.D.), University of Milan, Milan, Italy
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Tinti S, De Maria B, Parati M, Terzoni S, Rossi MC, Da Col D, Pairona G, Longhi C, Giudici E, Pidone I, Alberti A, Sofia M, Ramponi I, Urbano N, Tanaka K, Destrebecq A. Italian Version of Cancer Dyspnea Scale: Cultural-Linguistic and Clinical Validation in Patients With Advanced Cancer Disease in Palliative Care Settings. J Pain Symptom Manage 2021; 61:571-578.e1. [PMID: 33059018 DOI: 10.1016/j.jpainsymman.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT The Cancer Dyspnea Scale (CDS) is a self-reported multidimensional tool used for the assessment of dyspnea, a subjective experience of breathing discomfort, in patients with cancer. The scale describes dyspnea using three distinct factors: physical, psychological, and discomfort at rest. OBJECTIVES To crossculturally validate the Italian version of CDS (CDS-IT) and examine its content validity, feasibility, internal consistency, and construct validity in patients with advanced cancer. METHODS A cross-sectional study was conducted. CDS-IT was forward-backward translated, and its content was validated among a group of experts. Cronbach's α coefficients were used to assess the internal consistency. Construct validity was examined in terms of structural validity through confirmatory factor analysis, and convergent validity was examined with Visual Analogue Scale Dyspnea through the Pearson's correlation coefficient (r). Cancer Quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care) and Italian Palliative Outcome Scale were also tested. RESULTS The CDS-IT was crossculturally validated and showed satisfactory content validity. A total of 101 patients (mean age = 76 [SD = 12]; 53% females) were recruited in palliative care settings. CDS-IT reported a good internal consistency in the total score and its factors (α = 0.74-0.83). The factor analysis corresponded acceptably but not completely with the original study. CDS-IT strongly correlated with Visual Analogue Scale Dyspnea (r = 0.68) and moderately with Italian Palliative Outcome Scale and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (r = 0.33-0.36, respectively). CONCLUSION The study findings supported the crosscultural validity of the CDS-IT. Its feasibility, internal consistency, and construct validity are satisfactory for clinical practice. The CDS-IT is available to health care professionals as a useful tool to assess dyspnea in patients with cancer.
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Affiliation(s)
- Stefania Tinti
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
| | | | - Monica Parati
- IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy; Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Stefano Terzoni
- ASST- Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Maria Cristiana Rossi
- ASST-Rhodense, Palliative Care, Hospice and Pain Therapy Department, Garbagnate Milanese, Milan, Italy
| | - Daria Da Col
- ASST Grande Ospedale Metropolitano Niguarda, Palliative Care - Hospice, Milan, Italy
| | - Giulia Pairona
- ASST Grande Ospedale Metropolitano Niguarda, Palliative Care - Hospice, Milan, Italy
| | - Carla Longhi
- ASST-Lariana, Palliative Care - Hospice, Mariano Comense, Como, Italy
| | - Elisa Giudici
- ASST-Lariana, Palliative Care - Hospice, Mariano Comense, Como, Italy
| | - Irene Pidone
- ASST-Lariana, Palliative Care - Hospice, Mariano Comense, Como, Italy
| | - Annalisa Alberti
- ASST-Rhodense Bachelor School of Nursing, University of Milan, Rho, Milan, Italy
| | - Michele Sofia
- ASST-Rhodense, Palliative Care, Hospice and Pain Therapy Department, Garbagnate Milanese, Milan, Italy
| | - Ida Ramponi
- ASST-Rhodense, Garbagnate Milanese, Milan, Italy
| | - Nicla Urbano
- ASST-Rhodense, Garbagnate Milanese, Milan, Italy
| | - Keiko Tanaka
- Palliative Care Department Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Anne Destrebecq
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Damani A, Ghoshal A, Salins N, Deodhar J, Muckaden M. Validation of "Cancer Dyspnea Scale" in Patients With Advanced Cancer in a Palliative Care Setting in India. J Pain Symptom Manage 2017; 54:715-720.e1. [PMID: 28797864 DOI: 10.1016/j.jpainsymman.2017.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 05/15/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT Assessment of dyspnea in patients with advanced cancer is challenging. Cancer Dyspnea Scale (CDS) is a multidimensional scale developed for the measurement of dyspnea. It is available only in Japanese, English, and Swedish and has not been validated before in the Indian languages. OBJECTIVE The objective was to describe the process of validation and reliability testing of CDS in Indian advanced cancer patients. METHODS This is a prospective observational study conducted in the palliative care clinic of a tertiary cancer center in Mumbai. The English version of CDS was translated into Indian languages-Hindi (CDS-H) and Marathi (CDS-M). One hundred twenty newly registered eligible patients (60 for CDS-H and 60 for CDS-M) were enrolled into the study consecutively. They were asked to fill CDS (translated version) and Visual Analogue Scale for dyspnea. Only baseline measures were used. RESULTS Validity was separately analyzed for CDS-H and CDS-M. The results showed good construct validity between CDS-H and CDS-M. Intersubscale correlation was done by calculating the Pearson's correlation coefficient (mean r = 0.64 and 0.764 for CDS-H and CDS-M, respectively). Convergent validity was calculated by computing the correlation of each factor with VAS-D scores and was found statistically significant (P < 0.001; average r ranging from 0.706 to 0.714). Reliability of the scale was determined by its internal consistency (Cronbach's alpha coefficient ranging from 0.716 to 0.879). CONCLUSION This study demonstrates that CDS-H and CDS-M are valid and reliable multidimensional scales, which can be used to assess dyspnea in patients with advanced cancer.
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Affiliation(s)
- Anuja Damani
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Naveen Salins
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - MaryAnn Muckaden
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India.
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Abstract
BACKGROUND Dyspnoea consists of multiple dimensions including the intensity, unpleasantness, sensory qualities and emotional responses which may differ between patient groups, settings and in relation to treatment. The Dyspnoea-12 is a validated and convenient instrument for multidimensional measurement in English. We aimed to take forward a Swedish version of the Dyspnoea-12. METHODS The linguistic validation of the Dyspnoea-12 was performed (Mapi Language Services, Lyon, France). The standardised procedure involved forward and backward translations by three independent certified translators and revisions after feedback from an in-country linguistic consultant, the developerand three native physicians. The understanding and convenience of the translated version was evaluated using qualitative in-depth interviews with five patients with dyspnoea. RESULTS A Swedish version of the Dyspnoea-12 was elaborated and evaluated carefully according to international guidelines. The Swedish version, 'Dyspné-12', has the same layout as the original version, including 12 items distributed on seven physical and five affective items. The Dyspnoea-12 is copyrighted by the developer but can be used free of charge after permission for not industry-funded research. CONCLUSION A Swedish version of the Dyspnoea-12 is now available for clinical validation and multidimensional measurement across diseases and settings with the aim of improved evaluation and management of dyspnoea.
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Affiliation(s)
- Josefin Sundh
- Department of Respiratory Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Magnus Ekström
- Department of Clinical Sciences, Division of Respiratory Medicine & Allergology, Lund University, Lund, Sweden
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Tan JY, Yorke J, Harle A, Smith J, Blackhall F, Pilling M, Molassiotis A. Assessment of Breathlessness in Lung Cancer: Psychometric Properties of the Dyspnea-12 Questionnaire. J Pain Symptom Manage 2017; 53:208-215. [PMID: 27720789 DOI: 10.1016/j.jpainsymman.2016.08.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 07/20/2016] [Accepted: 08/04/2016] [Indexed: 12/26/2022]
Abstract
CONTEXT The Dyspnea-12 (D-12) Questionnaire is a well-validated instrument in respiratory illnesses for breathlessness assessment, but its psychometric properties have not been tested in lung cancer. OBJECTIVE To demonstrate the psychometric properties of the D-12 in lung cancer patients. METHODS Baseline data from a lung cancer feasibility trial were adopted for this analysis. D-12 and a series of patient-reported tools, including five Numeric Rating Scales (NRS), the Hospital Anxiety and Depression Scale (HADS), and the Lung Cancer Symptom Scale (LCSS), were used for the psychometric assessment. Spearman's correlation coefficients (rs) were used to estimate the convergent validity of the D-12 with the NRS, HADS, and LCSS. Exploratory factor analysis was performed to examine construct validity. Reliability was tested by Cronbach's alpha and item-to-total correlations. D-12 score difference between patients with or without anxiety, depression, and chronic obstructive pulmonary disease (COPD) was explored to identify its discriminate performance. RESULTS One hundred and one lung cancer patients were included. There were significantly positive correlations between the D-12 and the HADS, LCSS, and NRS measuring breathlessness severity and its associated affective distress. Factor analysis clearly identified two components (physical and emotional) of the D-12. Cronbach's alpha for D-12 total, physical, and emotional subscales was 0.95, 0.92, and 0.94, respectively. Patients with anxiety or depression demonstrated significantly higher D-12 scores than those without it, and patients with COPD reported significantly more severe breathlessness than those without COPD. CONCLUSION The D-12 is a valid and reliable self-reported questionnaire for use in breathlessness assessment in lung cancer patients.
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Affiliation(s)
- Jing-Yu Tan
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom; School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Janelle Yorke
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom.
| | - Amelie Harle
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jacky Smith
- Centre for Respiratory and Allergy, University Hospital South Manchester, Manchester, United Kingdom; Faculty of Medicine and Human Sciences, University of Manchester, Manchester, United Kingdom
| | - Fiona Blackhall
- The Christie NHS Foundation Trust, Manchester, United Kingdom; Faculty of Medicine and Human Sciences, University of Manchester, Manchester, United Kingdom
| | - Mark Pilling
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom
| | - Alex Molassiotis
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom; School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Koller M, Warncke S, Hjermstad MJ, Arraras J, Pompili C, Harle A, Johnson CD, Chie WC, Schulz C, Zeman F, van Meerbeeck JP, Kuliś D, Bottomley A. Use of the lung cancer-specific Quality of Life Questionnaire EORTC QLQ-LC13 in clinical trials: A systematic review of the literature 20 years after its development. Cancer 2015; 121:4300-23. [PMID: 26451520 DOI: 10.1002/cncr.29682] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/24/2015] [Accepted: 07/02/2015] [Indexed: 12/19/2022]
Abstract
The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) covers 13 typical symptoms of lung cancer patients and was the first module developed in conjunction with the EORTC core quality-of-life (QL) questionnaire. This review investigates how the module has been used and reported in cancer clinical trials in the 20 years since its publication. Thirty-six databases were searched with a prespecified algorithm. This search plus an additional hand search generated 770 hits, 240 of which were clinical studies. Two raters extracted data using a coding scheme. Analyses focused on the randomized controlled trials (RCTs). Of the 240 clinical studies that were identified using the LC13, 109 (45%) were RCTs. More than half of the RCTs were phase 3 trials (n = 58). Twenty RCTs considered QL as the primary endpoint, and 68 considered it as a secondary endpoint. QL results were addressed in the results section of the article (n = 89) or in the abstract (n = 92); and, in half of the articles, QL results were presented in the form of tables (n = 53) or figures (n = 43). Furthermore, QL results had an impact on the evaluation of the therapy that could be clearly demonstrated in the 47 RCTs that yielded QL differences between treatment and control groups. The EORTC QLQ-LC13 fulfilled its mission to be used as a standard instrument in lung cancer clinical trials. An update of the LC13 is underway to keep up with new therapeutic trends and to ensure optimized and relevant QL assessment in future trials.
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Affiliation(s)
- Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Sophie Warncke
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Marianne J Hjermstad
- Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital and European Palliative Care Research Centre, Department of Cancer and Molecular Medicine, Norwegian University of Science and Technology, Norway
| | - Juan Arraras
- Oncology Departments, Navarra Hospital Complex, Pamplona, Spain
| | - Cecilia Pompili
- Division of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom
| | - Amelie Harle
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Colin D Johnson
- University Surgical Unit, University Hospital Southampton, Hampshire, United Kingdom
| | - Wei-Chu Chie
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Christian Schulz
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
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Uronis HE, Shelby RA, Currow DC, Ahmedzai SH, Bosworth HB, Coan A, Abernethy AP. Assessment of the psychometric properties of an English version of the cancer dyspnea scale in people with advanced lung cancer. J Pain Symptom Manage 2012; 44:741-9. [PMID: 22765966 DOI: 10.1016/j.jpainsymman.2011.10.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 10/25/2011] [Accepted: 11/01/2011] [Indexed: 11/30/2022]
Abstract
CONTEXT Dyspnea is a poorly understood subjective sensation. Existing dyspnea measures fail to adequately address its multidimensionality. A Japanese group developed and validated the Cancer Dyspnea Scale (CDS) for assessing dyspnea in patients with advanced lung cancer. OBJECTIVES We evaluated the validity and reliability of the English version of the CDS (CDS-E) that has 12 items and takes, on average, 140 seconds for individuals to complete. METHODS Eligible patients had advanced lung cancer, consented, and were fluent in English. Participants completed a 100 mm visual analogue scale (VAS), the modified Borg scale, the CDS-E, the Hospital Anxiety and Depression Scale, and the Functional Assessment of Cancer Therapy--Lung quality-of-life scale. Demographic, radiographic, and treatment information were obtained from patients' medical records. RESULTS One hundred twelve participants were enrolled at three sites in the U.S., Australia, and the U.K. Mean age was 64.5 years (SD 11.5); 90% were Caucasian, 68% had Eastern Cooperative Oncology Group performance status 0-1, and 50% had non-small cell carcinoma. All completed the CDS-E independently, without difficulty. The CDS-E had reasonable internal consistency overall (Cronbach's α = 0.71) and for each of the three factors (effort, anxiety, discomfort Cronbach's α = 0.80-0.84). CDS-E scores were significantly correlated with the 100mm VAS (r = 0.82; P < 0.001) and the modified Borg (r = 0.87; P < 0.001). After factor analysis, the CDS-E was revised by removing three items (r-CDS-E). CONCLUSION The CDS-E and r-CDS-E are reliable and valid measures of the sensation and the psychological components of dyspnea, with the shorter version having similar psychometric properties.
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Affiliation(s)
- Hope E Uronis
- Division of Medical Oncology, Duke University Medical Center, Durham, NC 27710, USA
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Kamal AH, Maguire JM, Wheeler JL, Currow DC, Abernethy AP. Dyspnea review for the palliative care professional: assessment, burdens, and etiologies. J Palliat Med 2011; 14:1167-72. [PMID: 21895451 PMCID: PMC3189385 DOI: 10.1089/jpm.2011.0109] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dyspnea is a common symptom experienced by many patients with chronic, life-threatening, and/or life-limiting illnesses. Although it can be defined and measured in several ways, dyspnea is best described directly by patients through regular assessment, as its burdens exert a strong influence on the patient's experience throughout the trajectory of serious illness. Its significance is amplified due to its impact on family and caregivers. DISCUSSION Anatomic and physiologic changes associated with dyspnea, and cognitive perceptions related to patients and the underlying disease, provide insights into how to shape interventions targeting this oppressive symptom. Additionally, as described in the concept of "total dyspnea," the complex etiology and manifestation of this symptom require multidisciplinary treatment plans that focus on psychological, social, and spiritual distress as well as physical components. Several validated assessment tools are available for clinical and research use, and choice of method should be tailored to the individual patient, disease, and care setting in the context of patient-centered care. CONCLUSION This article, the first in a two-part series, reviews the identification and assessment of dyspnea, the burden it entails, and the underlying respiratory and nonrespiratory etiologies that may cause or exacerbate it.
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Affiliation(s)
- Arif H. Kamal
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina
| | - Jennifer M. Maguire
- Department of Medicine, Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Jane L. Wheeler
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina
| | - David C. Currow
- Department of Palliative and Supportive Services, Division of Medicine, Flinders University, Bedford Park, South Australia, Australia
| | - Amy P. Abernethy
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina
- Department of Palliative and Supportive Services, Division of Medicine, Flinders University, Bedford Park, South Australia, Australia
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Dorman S, Jolley C, Abernethy A, Currow D, Johnson M, Farquhar M, Griffiths G, Peel T, Moosavi S, Byrne A, Wilcock A, Alloway L, Bausewein C, Higginson I, Booth S. Researching breathlessness in palliative care: consensus statement of the National Cancer Research Institute Palliative Care Breathlessness Subgroup. Palliat Med 2009; 23:213-27. [PMID: 19251835 DOI: 10.1177/0269216309102520] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Breathlessness is common in advanced disease and can have a devastating impact on patients and carers. Research on the management of breathlessness is challenging. There are relatively few studies, and many studies are limited by inadequate power or design. This paper represents a consensus statement of the National Cancer Research Institute Palliative Care Breathlessness Subgroup. The aims of this paper are to facilitate the design of adequately powered multi-centre interventional studies in breathlessness, to suggest a standardised, rational approach to breathlessness research and to aid future 'between study' comparisons. Discussion of the physiology of breathlessness is included.
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Affiliation(s)
- S Dorman
- Poole Hospital NHS Foundation Trust, Longfleet Road, Poole.
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Henoch I, Bergman B, Gustafsson M, Gaston-Johansson F, Danielson E. Dyspnea experience in patients with lung cancer in palliative care. Eur J Oncol Nurs 2008; 12:86-96. [DOI: 10.1016/j.ejon.2007.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2006] [Revised: 08/21/2007] [Accepted: 09/18/2007] [Indexed: 11/25/2022]
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Henoch I, Bergman B, Gustafsson M, Gaston-Johansson F, Danielson E. The impact of symptoms, coping capacity, and social support on quality of life experience over time in patients with lung cancer. J Pain Symptom Manage 2007; 34:370-9. [PMID: 17616335 DOI: 10.1016/j.jpainsymman.2006.12.005] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2006] [Revised: 12/04/2006] [Accepted: 12/06/2006] [Indexed: 11/19/2022]
Abstract
The aims of the study were to investigate lung cancer patients' quality of life (QoL) over time in a palliative setting and to determine how QoL is influenced by symptoms, coping capacity, and social support. One hundred and five consecutive patients with incurable lung cancer were included. A comprehensive set of questionnaires was used at baseline, including the Assessment of Quality of Life at the End of Life, Cancer Dyspnea Scale, Visual Analog Scale of Dyspnea, Hospital Anxiety and Depression scale, Sense of Coherence Questionnaire, and Social Support Survey, of which the first four were used also at three, six, nine, and 12 months. Dyspnea, depression, and global QoL deteriorated over time. Performance status, anxiety, depression, components of dyspnea, pain, and the meaningfulness component of coping capacity correlated with global QoL at all, or all but one follow-up measurements. In a multivariate analysis with global QoL as the dependent variable, depression was a significant predictor at four out of five assessments, whereas coping capacity, anxiety, performance status, pain, and social support entered the model at one or two assessments. Emotional distress and coping capacity influence QoL and might be targets for intervention in palliative care.
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Affiliation(s)
- Ingela Henoch
- Institute of Health and Care Sciences and Department of Respiratory Medicine and Allergology, Sahlgrenska Academy at Göteborg University, Dr. Forselius gata 4, S-413 26 Göteborg, Sweden.
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Abstract
BACKGROUND AND RESEARCH OBJECTIVE Although dyspnea is a frequently encountered clinical symptom, precise clinical evaluation of this sensation remains illusive. Dyspnea has been difficult to evaluate empirically, as severity of mechanical pulmonary impairment does not appear to correlate with subjectively reported levels of dyspnea. The purpose of this study was to describe changes in dyspnea and blood pressure with the use of an incentive spirometry and to examine the relationship of such changes in patients with chronic obstructive pulmonary disease. SUBJECTS AND METHODS A convenience sample of 60 adults diagnosed with chronic obstructive pulmonary disease was recruited from ambulatory outpatient clinics at a large Veterans hospital. A quantitative single-group, within-subjects repeated-measure design was used to investigate the relationship between the variables following incentive spirometry. Dyspnea levels were recorded with the visual analog scale and arterial blood pressures (beat-to-beat systolic, mean, and diastolic) were continuously recorded with tonometry. RESULTS AND CONCLUSIONS The first 4 periods following use of the incentive spirometer were found to have statistically significant increases from dyspnea baseline scores (F = 77.4, P < .001). The baseline of each of the arterial blood pressure measurements, systolic, mean, and diastolic, were found to have significant differences with all of the 6 postintervention time points (systolic F = 8.0, P < .001; mean F = 7.1, P < .001; diastolic F = 7.2, P < .001). The changes in dyspnea scores and blood pressure measurements were found to have significant inverse correlations at the immediate postintervention time point (r = -0.32 to -0.35, P < .01). Results provide evidence of an inverse relationship between dyspnea and blood pressure patterns and may indicate significant clinical associations to add to the body of knowledge about the symptom of dyspnea.
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