1
|
Tunnell NC, Corner SE, Roque AD, Kroll JL, Ritz T, Meuret AE. Biobehavioral approach to distinguishing panic symptoms from medical illness. Front Psychiatry 2024; 15:1296569. [PMID: 38779550 PMCID: PMC11109415 DOI: 10.3389/fpsyt.2024.1296569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/19/2024] [Indexed: 05/25/2024] Open
Abstract
Panic disorder is a common psychiatric diagnosis characterized by acute, distressing somatic symptoms that mimic medically-relevant symptoms. As a result, individuals with panic disorder overutilize personal and healthcare resources in an attempt to diagnose and treat physical symptoms that are often medically benign. A biobehavioral perspective on these symptoms is needed that integrates psychological and medical knowledge to avoid costly treatments and prolonged suffering. This narrative review examines six common somatic symptoms of panic attacks (non-cardiac chest pain, palpitations, dyspnea, dizziness, abdominal distress, and paresthesia), identified in the literature as the most severe, prevalent, or critical for differential diagnosis in somatic illness, including long COVID. We review somatic illnesses that are commonly comorbid or produce panic-like symptoms, their relevant risk factors, characteristics that assist in distinguishing them from panic, and treatment approaches that are typical for these conditions. Additionally, this review discusses key factors, including cultural considerations, to assist healthcare professionals in differentiating benign from medically relevant symptoms in panic sufferers.
Collapse
Affiliation(s)
- Natalie C. Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Psychiatry & Behavioral Sciences, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Sarah E. Corner
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Andres D. Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Primary Care Department, Miami VA Healthcare System, Miami, FL, United States
| | - Juliet L. Kroll
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Alicia E. Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| |
Collapse
|
2
|
Pavy F, Torta DM, von Leupoldt A. The effect of unpredictability on the perception of breathlessness: a narrative review. FRONTIERS IN REHABILITATION SCIENCES 2024; 4:1339072. [PMID: 38264214 PMCID: PMC10803486 DOI: 10.3389/fresc.2023.1339072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024]
Abstract
Breathlessness is an aversive bodily sensation impacting millions of people worldwide. It is often highly detrimental for patients and can lead to profound distress and suffering. Notably, unpredictable breathlessness episodes are often reported as being more severe and unpleasant than predictable episodes, but the underlying reasons have not yet been firmly established in experimental studies. This review aimed to summarize the available empirical evidence about the perception of unpredictable breathlessness in the adult population. Specifically, we examined: (1) effects of unpredictable relative to predictable episodes of breathlessness on their perceived intensity and unpleasantness, (2) potentially associated neural and psychophysiological correlates, (3) potentially related factors such as state and trait negative affectivity. Nine studies were identified and integrated in this review, all of them conducted in healthy adult participants. The main finding across studies suggested that unpredictable compared to predictable, breathlessness elicits more frequently states of high fear and distress, which may contribute to amplify the perception of unpredictable breathlessness, especially its unpleasantness. Trait negative affectivity did not seem to directly affect the perception of unpredictable breathlessness. However, it seemed to reinforce state fear and anxiety, hence possible indirect modulatory pathways through these affective states. Studies investigating neural correlates of breathlessness perception and psychophysiological measures did not show clear associations with unpredictability. We discuss the implication of these results for future research and clinical applications, which necessitate further investigations, especially in clinical samples suffering from breathlessness.
Collapse
Affiliation(s)
- Fabien Pavy
- Research Group Health Psychology, Department of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | | | | |
Collapse
|
3
|
Hill K, Hug S, Smith A, O’Sullivan P. The Role of Illness Perceptions in Dyspnoea-Related Fear in Chronic Obstructive Pulmonary Disease. J Clin Med 2023; 13:200. [PMID: 38202207 PMCID: PMC10780095 DOI: 10.3390/jcm13010200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
Dyspnoea is often the most distressing symptom described by people with a chronic respiratory condition. The traditional biomedical model of neuromechanical uncoupling that explains the physiological basis for dyspnoea is well accepted. However, in people with chronic obstructive pulmonary disease (COPD), measures that are linked with neuromechanical uncoupling are poorly related to the restriction in activity during daily life attributed to dyspnoea. This suggests that activity restriction that results from dyspnoea is influenced by factors other than expiratory airflow limitation and dynamic pulmonary hyperinflation, such as the ways people perceive, interpret and respond to this sensation. This review introduces the common-sense model as a framework to understand the way an individual's lay beliefs surrounding sensations can lead to these sensations being perceived as a health threat and how this impacts their emotional and behavioural responses. The aim is to provide insight into the nuances that can shape an individual's personal construct of dyspnoea and offer practical suggestions to challenge unhelpful beliefs and facilitate cognitive re-structuring as a pathway to reduce distress and optimise health behaviours and outcomes.
Collapse
Affiliation(s)
- Kylie Hill
- Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia; (S.H.); (A.S.); (P.O.)
| | - Sarah Hug
- Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia; (S.H.); (A.S.); (P.O.)
- Physiotherapy Department, Royal Perth Hospital, Victoria Square, Perth, WA 6000, Australia
| | - Anne Smith
- Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia; (S.H.); (A.S.); (P.O.)
| | - Peter O’Sullivan
- Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia; (S.H.); (A.S.); (P.O.)
| |
Collapse
|
4
|
Johnston KN, Burgess R, Kochovska S, Williams MT. Exploring the Experience of Breathlessness with the Common-Sense Model of Self-Regulation (CSM). Healthcare (Basel) 2023; 11:1686. [PMID: 37372804 DOI: 10.3390/healthcare11121686] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic breathlessness is a multidimensional, unpleasant symptom common to many health conditions. The Common-Sense Model of Self-Regulation (CSM) was developed to help understand how individuals make sense of their illness. This model has been underused in the study of breathlessness, especially in considering how information sources are integrated within an individual's cognitive and emotional representations of breathlessness. This descriptive qualitative study explored breathlessness beliefs, expectations, and language preferences of people experiencing chronic breathlessness using the CSM. Twenty-one community-dwelling individuals living with varying levels of breathlessness-related impairment were purposively recruited. Semi-structured interviews were conducted with questions reflecting components of the CSM. Interview transcripts were synthesized using deductive and inductive content analysis. Nineteen analytical categories emerged describing a range of cognitive and emotional breathlessness representations. Representations were developed through participants' personal experience and information from external sources including health professionals and the internet. Specific words and phrases about breathlessness with helpful or nonhelpful connotations were identified as contributors to breathlessness representations. The CSM aligns with current multidimensional models of breathlessness and provides health professionals with a robust theoretical framework for exploring breathlessness beliefs and expectations.
Collapse
Affiliation(s)
- Kylie N Johnston
- Allied Health and Human Performance, Innovation, IMPlementation and Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, SA 5001, Australia
| | - Rebecca Burgess
- Allied Health and Human Performance, Innovation, IMPlementation and Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, SA 5001, Australia
| | - Slavica Kochovska
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Marie T Williams
- Allied Health and Human Performance, Innovation, IMPlementation and Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, SA 5001, Australia
| |
Collapse
|
5
|
Lizarazo Pereira DM, Schubert TW, Roth J. Moved by Social Justice: The Role of Kama Muta in Collective Action Toward Racial Equality. Front Psychol 2022; 13:780615. [PMID: 35300167 PMCID: PMC8921536 DOI: 10.3389/fpsyg.2022.780615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Participation in collective action is known to be driven by two appraisals of a social situation: Beliefs that the situation is unfair (injustice appraisal) and beliefs that a group can change the situation (collective efficacy appraisal). Anger has been repeatedly found to mediate the relationship between injustice appraisals and collective action. Recent work suggests that the emotion of being moved mediates the relationship between efficacy appraisals and collective action. Building on this prior work, the present research applies kama muta theory to further investigate the relationship between efficacy appraisals and collective action. Kama muta is a positive emotion that is evoked by a sudden intensification of communal sharing, and largely overlaps with the English concept being moved. We investigated its relationship with collective action in both advantaged and disadvantaged racial groups in the context of the Black Lives Matter Movement (BLM) in Spring of 2020. In one pilot study (N = 78) and one main study (N = 215), we confirmed that anger toward the system of racial inequalities mediated between injustice and collective action intentions, and that kama muta toward the movement mediated between collective efficacy and collective action intentions. Both mediations were found for both Black and White participants. We also observed additional unpredicted paths from anger to kama muta and from efficacy to anger. Together, this provides evidence for the pivotal role of emotions in collective action intentions, but also points out that appraisals need to be better understood.
Collapse
Affiliation(s)
- Diana M. Lizarazo Pereira
- Department of Psychology, Universitetet i Oslo, Oslo, Norway
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Thomas W. Schubert
- Department of Psychology, Universitetet i Oslo, Oslo, Norway
- CIS-IUL, ISCTE-Instituto Universitário de Lisboa, Lisbon, Portugal
| | - Jenny Roth
- Department of Psychology, University of Limerick, Limerick, Ireland
| |
Collapse
|
6
|
Higginson IJ, Reilly CC, Maddocks M. Breathlessness. Respir Med 2021. [DOI: 10.1007/978-3-030-81788-6_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
7
|
Garcia MV, Luckett T, Johnson M, Hutchinson A, Lal S, Phillips JL. The roles of dispositional coping style and social support in helping people with respiratory disease cope with a breathlessness crisis. J Adv Nurs 2019; 75:1953-1965. [PMID: 31012133 DOI: 10.1111/jan.14039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/12/2019] [Accepted: 03/28/2019] [Indexed: 12/01/2022]
Abstract
AIM To explore the role of coping moderators in self-management of breathlessness crises by people with advanced respiratory disease. DESIGN A secondary analysis of semi-structured interview data. METHODS Interviews with patients who had advanced respiratory disease, chronic breathlessness and at least one experience where they considered presenting to Emergency but self-managed instead (a "near miss"). Participants were recruited from New South Wales, Queensland, Victoria, South Australia or Tasmania. Eligible caregivers were those who contributed to Emergency-related decision-making. Interviews were coded inductively and then deductively against the coping moderators social support and dispositional coping style, defined by the Transactional Model of Stress and Coping. RESULTS Interviews were conducted between October 2015 - April 2016 with 20 patients and three caregivers. Social networks offered emotional and practical support but also had potential for conflict with patients' 'hardy' coping style. Patient hardiness (characterized by a sense of 'commitment' and 'challenge') promoted a proactive approach to self-management but made some patients less willing to accept support. Information-seeking tendencies varied between patients and were sometimes shared with caregivers. An optimistic coping style appeared to be less equivocally beneficial. CONCLUSION This study shows that social support and coping style may influence how people self-manage through their breathlessness crises and identified ways coping moderators can facilitate or hinder effective self-management. IMPACT This study confers insights into how social-support and coping style can be supported and optimized to facilitate breathlessness self-management. Acknowledging coping moderator interactions is beneficial for developing resources and strategies that recognise patient mastery.
Collapse
Affiliation(s)
- Maja Villanueva Garcia
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Tim Luckett
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Miriam Johnson
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Ann Hutchinson
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Sara Lal
- School of Life Sciences, University of Technology, Sydney, New South Wales, Australia
| | - Jane L Phillips
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
8
|
Lovell N, Etkind SN, Bajwah S, Maddocks M, Higginson IJ. Control and Context Are Central for People With Advanced Illness Experiencing Breathlessness: A Systematic Review and Thematic Synthesis. J Pain Symptom Manage 2019; 57:140-155.e2. [PMID: 30291949 DOI: 10.1016/j.jpainsymman.2018.09.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 12/01/2022]
Abstract
CONTEXT Breathlessness is common and distressing in advanced illness. It is a challenge to assess, with few effective treatment options. To evaluate new treatments, appropriate outcome measures that reflect the concerns of people experiencing breathlessness are needed. OBJECTIVES The objective of this study was to systematically review and synthesize the main concerns of people with advanced illness experiencing breathlessness to guide comprehensive clinical assessment and inform future outcome measurement in clinical practice and research. METHODS This is a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. MEDLINE (1946-2017), PsycINFO (1806-2017), and EMBASE (1974-2017), as well as key journals, gray literature, reference lists, and citation searches, identified qualitative studies exploring the concerns of people living with breathlessness. Included studies were quality-assessed using the Critical Appraisal Skills Program checklist and analyzed using thematic synthesis. RESULTS We included 38 studies with 672 participants. Concerns were identified across six domains of "total" breathlessness: physical, emotional, spiritual, social, control, and context (chronic and episodic breathlessness). Four of these have been previously identified in the concept of "total dyspnea." Control and context have been newly identified as important, particularly in their influence on coping and help-seeking behavior. The importance of social participation, impact on relationships, and loss of perceived role within social and spiritual domains also emerged as being significant to individuals. CONCLUSION People with advanced illness living with breathlessness have concerns in multiple domains, supporting a concept of "total breathlessness." This adapted model can help to guide comprehensive clinical assessment and inform future outcome measurement in clinical practice and research.
Collapse
Affiliation(s)
- Natasha Lovell
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom.
| | - Simon N Etkind
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| |
Collapse
|
9
|
Booth S, Chin C, Spathis A, Maddocks M, Yorke J, Burkin J, Moffat C, Farquhar M, Bausewein C. Non-pharmacological interventions for breathlessness in people with cancer. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23809000.2018.1524708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Sara Booth
- Associate Lecturer University of Cambridge, Cambridge Breathlessness Intervention Service (CBIS), Cambridge, UK
| | - Chloe Chin
- Consultant in Palliative Medicine, Camden, Islington, ELiPSE and UCLH & HCA
| | | | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Janelle Yorke
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Julie Burkin
- Associate Lecturer University of Cambridge, Cambridge Breathlessness Intervention Service (CBIS), Cambridge, UK
| | | | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Claudia Bausewein
- Klinik und Poliklinik für Palliativmedizin, Klinikum der Universität München, München, Germany
| |
Collapse
|
10
|
Stowe E, Wagland R. A qualitative exploration of distress associated with episodic breathlessness in advanced lung cancer. Eur J Oncol Nurs 2018; 34:76-81. [PMID: 29784142 DOI: 10.1016/j.ejon.2018.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 03/22/2018] [Accepted: 03/26/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE Breathlessness is a distressing symptom, particularly common in those with advanced lung cancer. Previous research has identified the symptom occurrence of episodic breathlessness, identifying average frequency, duration and severity of episodes, but has not explored the distress specifically associated with these episodes. This study explored the distress associated with episodic breathlessness for adults with advanced cancer and the relative impact of three elements; frequency, duration or severity. METHODS Semi-structured interviews were conducted with four participants with advanced lung cancer. Analysis adopted an interpretative phenomenological approach. RESULTS A complex relationship existed between distress caused by episodic breathlessness and its frequency, duration and severity for study participants. Episodic breathlessness had a significant impact on participant's perceptions of self and previous experience effected how distressed they were by their breathlessness. The emotional work created by the symptom was considerable for individuals. CONCLUSION The study highlights the importance of recognizing symptoms as a combination of different experiences that may each cause different levels of distress. Initial evidence is provided that the emotional work involved for patients to self-manage each separate element of breathlessness should be considered in its treatment.
Collapse
Affiliation(s)
- Emily Stowe
- St Clare Hospice, Hastingwood Road, Hastingwood, Essex, CM17 9JX, United Kingdom.
| | - Richard Wagland
- Faculty of Health Sciences, Building 67, Highfield, University of Southampton, SO17 1BJ, United Kingdom.
| |
Collapse
|
11
|
Hutchinson A, Barclay-Klingle N, Galvin K, Johnson MJ. Living with breathlessness: a systematic literature review and qualitative synthesis. Eur Respir J 2018; 51:51/2/1701477. [PMID: 29467199 DOI: 10.1183/13993003.01477-2017] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/09/2017] [Indexed: 02/03/2023]
Abstract
What is the experience of people living with breathlessness due to medical conditions, those caring for them and those treating them, with regard to quality of life and the nature of clinical interactions?Electronic databases (Ovid MEDLINE, Embase, CINAHL Plus and PsycINFO) were searched (January 1987 to October 2017; English language), for qualitative studies exploring the experience of chronic breathlessness (patients, carers and clinicians). Two independent reviewers screened titles, abstracts and papers retrieved against inclusion criteria. Disagreements were resolved with a third reviewer. Primary qualitative data were extracted and synthesised using thematic synthesis.Inclusion and synthesis of 101 out of 2303 international papers produced four descriptive themes: 1) widespread effects of breathlessness; 2) coping; 3) help-seeking behaviour; and 4) clinicians' responsiveness to the symptom of breathlessness. The themes were combined to form the concept of "breathing space", to show how engaged coping and appropriate help-seeking (patient) and attention to symptom (clinician) helps maximise the patient's quality of living with breathlessness.Breathlessness has widespread impact on both patient and carer and affects breathing space. The degree of breathing space is influenced by interaction between the patient's coping style, their help-seeking behaviour and their clinician's responsiveness to breathlessness itself, in addition to managing the underlying disease.
Collapse
|
12
|
Developing and evaluating psychological provision in the acute hospital setting for patients with chronic respiratory disease. COGNITIVE BEHAVIOUR THERAPIST 2017. [DOI: 10.1017/s1754470x17000071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractPhysical health outcomes for patients with long-term conditions can be significantly affected by their psychological wellbeing; those experiencing psychological difficulties are less able to manage symptoms, have a poorer quality of life, and more frequent hospital admissions. National guidance recommends the assessment and treatment of psychological difficulties secondary to respiratory disease, but implementation of this across services is inconsistent. Here, we describe the process and findings of a 9-month study integrating psychological assessment and intervention into an acute respiratory department. The aim of this provision was to provide appropriate interventions for both in-patients and out-patients with identified psychological needs, and to evaluate the impact of these across a range of outcome domains. Psychological assessment and intervention was flexibly implemented as clinically appropriate within the context of the wider multidisciplinary team. Hospital admissions data were collated, and feedback obtained from both patients and staff. Results highlighted that psychological provision was well received by both patients and staff, and was associated with improved patient experiences and a greater focus on holistic care. Of the 73 patients receiving psychology input with at least 1 month of follow-up data, 75% showed a reduction in their admission frequency following intervention. The estimated savings to the wider NHS exceeded the costs of providing psychology input. In light of existing literature, national guidance, and the present findings, we highlight the need for those commissioning and managing respiratory services to consider the various potential benefits of integrating psychological provision for a patient group with high levels of psychological need.
Collapse
|
13
|
Reilly CC, Bausewein C, Pannell C, Moxham J, Jolley CJ, Higginson IJ. Patients' experiences of a new integrated breathlessness support service for patients with refractory breathlessness: Results of a postal survey. Palliat Med 2016; 30:313-22. [PMID: 26311570 PMCID: PMC4778380 DOI: 10.1177/0269216315600103] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We developed a new single point of access to integrated palliative care, respiratory medicine and physiotherapy: the breathlessness support service for patients with advanced disease and refractory breathlessness. This study aimed to describe patients' experiences of the service and identify the aspects valued. DESIGN We attempted to survey all patients who had attended and completed the 6-week breathlessness support service intervention by sending them a postal questionnaire to self-complete covering experience, composition, effectiveness of the BSS and about participation in research. Data were analysed using descriptive statistics and thematic analysis of free text comments. RESULTS Of the 70 postal questionnaires sent out, 25 (36%) returned. A total of 21 (84% (95% confidence interval: 69%-98%)) responding patients reported that they definitely found the breathlessness support service helpful and 13 (52% (95% confidence interval: 32%-72%)) rated the breathlessness support service as excellent. A total of 21 (84% (95% confidence interval: 69%-98%)) patients reported that the breathlessness support service helped with their management of their breathlessness along with additional symptoms and activities (e.g. mood and mobility). Four key themes were identified: (1) personalised care, (2) caring nature of the staff, (3) importance of patient education to empower patients and (4) effectiveness of context-specific breathlessness interventions. These were specific aspects that patients valued. CONCLUSION Patients' satisfaction with the breathlessness support service was high, and identified as important to this was a combination of personalised care, nature of staff, education and empowerment, and use of specific interventions. These components would be important in any future breathlessness service.
Collapse
Affiliation(s)
- Charles C Reilly
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Claudia Bausewein
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK Department for Palliative Medicine, Munich University Hospital, Munich, Germany
| | - Caty Pannell
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - John Moxham
- Department of Asthma, Allergy and Respiratory Science, King's College London, London, UK
| | - Caroline J Jolley
- Department of Asthma, Allergy and Respiratory Science, King's College London, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| |
Collapse
|
14
|
Halpin D, Hyland M, Blake S, Seamark C, Pinnuck M, Ward D, Whalley B, Greaves C, Hawkins A, Seamark D. Understanding fear and anxiety in patients at the time of an exacerbation of chronic obstructive pulmonary disease: a qualitative study. JRSM Open 2015; 6:2054270415614543. [PMID: 26664734 PMCID: PMC4668916 DOI: 10.1177/2054270415614543] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To determine the importance of fear and anxiety at the time of an exacerbation of chronic obstructive pulmonary disease. To assess the influence of carers and health professionals on this fear and anxiety. DESIGN A qualitative study to elicit the views of patients and their carers during a hospital admission for exacerbations of chronic obstructive pulmonary disease. SETTING Interviews were conducted in a District General Hospital. PARTICIPANTS Twenty patients were interviewed shortly after admission to hospital with an exacerbation. MAIN OUTCOME MEASURES Key themes were identified using cross-sectional thematic analysis of transcripts where commonalities and differences were identified. RESULTS Four themes emerged: panic and fear; anxiety management techniques used during an exacerbation; intervention from family members and carers; response to medical services. CONCLUSION Panic and fear are important emotions prior to admission. Many patients recognised the link between panic-fear and a worsening of symptoms, and some were able to use self-management techniques to reduce their panic-fear. Some relatives were seen as helping and others exacerbating the symptoms of panic-fear. The emergency services were seen as positive: providing reassurance and a sense of safety. How best to help patients with chronic obstructive pulmonary disease manage panic and fear remains a challenge.
Collapse
Affiliation(s)
- David Halpin
- Department of Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter EX2 5DW, UK
| | - Michael Hyland
- School of Psychology, University of Plymouth, Plymouth PL4 8AA, UK
| | - Susan Blake
- The Honiton Group Practice, Honiton EX14 2NY, UK
| | | | | | - David Ward
- The Honiton Group Practice, Honiton EX14 2NY, UK
| | - Ben Whalley
- School of Psychology, University of Plymouth, Plymouth PL4 8AA, UK
| | - Colin Greaves
- Department of Primary Care, University of Exeter Medical School, Exeter EX1 2LU, UK
| | - Adam Hawkins
- GSK Respiratory Global Franchise, Exeter UB11 1BT, UK
| | | |
Collapse
|
15
|
Solomon BK, Wilson KG, Henderson PR, Poulin PA, Kowal J, McKim DA. A Breathlessness Catastrophizing Scale for chronic obstructive pulmonary disease. J Psychosom Res 2015; 79:62-8. [PMID: 25498317 DOI: 10.1016/j.jpsychores.2014.11.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/22/2014] [Accepted: 11/25/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Catastrophizing about breathlessness may be related to disability in patients with chronic obstructive pulmonary disease (COPD), but assessment options are limited. This study reports the initial validation of a 13-item Breathlessness Catastrophizing Scale (BCS). METHOD Pulmonary rehabilitation inpatients completed spirometric, functional performance and questionnaire assessments at admission (N=242) and discharge (n=186). RESULTS The BCS comprised a unifactorial scale that demonstrated excellent internal consistency (Cronbach's alpha=.96) and correlated with measures of anxiety sensitivity, depression, and self-efficacy, but not with performance on walk and stair-climbing tests. BCS scores improved robustly with rehabilitation, approaching a medium effect size (d=.43), and demonstrated a modest association with enhanced performance in a stair-climbing test of exercise tolerance. CONCLUSION The BCS is a reliable measure of catastrophizing in severe COPD that has good convergent validity and sensitivity to change. Its association with functional performance requires further investigation. However, it appears that a high level of catastrophizing about breathlessness is not a barrier to functional improvement with inpatient pulmonary rehabilitation.
Collapse
Affiliation(s)
| | - Keith G Wilson
- Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Canada
| | - Peter R Henderson
- Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Canada
| | | | - John Kowal
- Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Canada
| | | |
Collapse
|
16
|
Howard C, Dupont S. 'The COPD breathlessness manual': a randomised controlled trial to test a cognitive-behavioural manual versus information booklets on health service use, mood and health status, in patients with chronic obstructive pulmonary disease. NPJ Prim Care Respir Med 2014; 24:14076. [PMID: 25322078 PMCID: PMC4373470 DOI: 10.1038/npjpcrm.2014.76] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 07/18/2014] [Accepted: 08/12/2014] [Indexed: 11/09/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a costly long-term condition associated with frequent Accident and Emergency (A&E) and hospital admissions. Psychological difficulties and inadequate self-management can amplify this picture. Aims: To compare a cognitive-behavioural manual versus information booklets (IB) on health service use, mood and health status. Methods: Two hundred and twenty-two COPD patients were randomly allocated to receive either the COPD breathlessness manual (CM) or IB. They were instructed to work through their programme at home, over 5 weeks. Guidance from a facilitator was provided at an initial home visit plus two telephone call follow-ups. Results: After 12 months, total A&E visits had reduced by 42% in the CM group, compared with a 16% rise in the IB group. The odds of people in the IB group attending A&E 12 months post-intervention was 1.9 times higher than for the CM group (CI 1.05–3.53). Reduction in hospital admissions and bed days were greatest in the CM group. At 6 months, there were significantly greater improvements in anxiety (F (2,198)=5.612, P=0.004), depression (F (1.8,176.1)=10.697, P⩽0.001) and dyspnoea (F (2,198)=18.170, P⩽0.001) in the CM group. Estimated savings at 12 months were greatest in the CM group, amounting to £30k or £270 per participant. Conclusion: The COPD manual, which addresses physical and mental health, is a straightforward cost-effective intervention that is worth offering to COPD patients within primary or secondary care.
Collapse
Affiliation(s)
- Claire Howard
- Department of Clinical Health Psychology, Central and North West London NHS Foundation Trust, The Hillingdon Hospital, Pield Heath Road, Uxbridge, UK
| | - Simon Dupont
- Department of Clinical Health Psychology, Central and North West London NHS Foundation Trust, The Hillingdon Hospital, Pield Heath Road, Uxbridge, UK
| |
Collapse
|