Effect of Perceived Dyspnea on Attitude Toward Death From the Perspective of COPD Patients

Existential aspects of breathlessness in serious disease

PURPOSE OF THE REVIEW

Breathlessness may evoke existential threat but may also affect the person with serious illness or their caregiver/s in other important ways which can be considered 'existential'. This review explores existential aspects of breathlessness in people with serious illness and presents recent studies of assessment and management of associated distress and suffering.

RECENT FINDINGS

Both existential distress and breathlessness are multidimensional and include a range of constructs, many of which have behavioural consequences. Existential distress tracks closely with distressing breathing potentially due to shared underlying neurobiological processing. Paradoxically 'contagious' and isolating effects of breathlessness and related distress have been recently highlighted. Approaches to screening and assessment vary. Preliminary studies have investigated novel approaches to breathing-related anxiety and existential distress.

SUMMARY

Studies with existential constructs as outcome measures in people with breathlessness are scarce. Interventions for existential distress developed for those with malignant disease may be beneficial for those with non-malignant conditions, but adaptations may be required. Recently proposed taxonomies of existential distress/concerns may guide assessment and direct novel therapeutic interventions in people living with serious illness and breathlessness-related distress. Neglecting existential aspects of breathlessness represents a missed opportunity to support holistic well-being in people with serious illness.

Moderating Effect of Dyspnea in the Relationship Between Death Anxiety and Self-Management in COPD: A Structural Equation Modeling Analysis

The study was conducted to examine the moderating effect of dyspnea (according to Modified Medical Research Council-mMRC scale) on the relationship between death anxiety (DA) and self-management (SM) levels in patients suffering from chronic obstructive pulmonary disease (COPD) (n = 313). Model fit indices are within appropriate limits (χ2/DF = 2.284, GFI = .855, CFI = .796, RMSEA = .064). In mMRC 2, females had 33 times more DA than males. In mMRC 3, DA increased 36 times with increasing age and 14 times with comorbidity. It decreased 15-fold in those with past exacerbation experience. The second model explained DA by 18% while the moderating effect of severe dyspnea contributed 28% to this association. In this group of patients, a one unit increase in DA led to a 53-fold increase in SM. Age, gender, comorbidity and previous exacerbation history affect DA in patients with COPD. Increased DA decreases self-management. Severe dyspnea has a moderating effect between DA and SM.

Investigation of immunosuppressive treatment compliance, dyspnea, anxiety, and depression levels in lung transplant recipients: online interview

Introduction

Following lung transplantation (LTx), it is important for recipients to comply with immunosuppressive treatment and cope with related problems. In the post-LTx period, the course of dyspnea and psychological problems it causes in case of progression are not known. Depression and anxiety may develop in recipients after LTx. However, the relationship between this situation and treatment compliance and dyspnea is uncertain.

Objective

The aim of this study was to investigate dyspnea, anxiety, and depression levels of recipients following LTx and their immunosuppressive treatment compliance.

Method

The study was planned as a descriptive, correlational, and cross-sectional study. Data were collected on various social media platforms via an online interview, and 65 LTx recipients were included in the sample (n = 65). A Participant Information Form, the Modified Borg Scale, the Beck Anxiety Inventory, the Beck Depression Inventory, and the Immunosuppressive Drug Compliance Scale were employed to collect data. The collected data were analyzed using descriptive statistics, the Mann-Whitney U test, and the Kruskal-Wallis test.

Results

The mean age of the participants was found to be 52.60 ± 9.44 years, and 56.9% were male. Forty percent of the participants were dependent on oxygen support, and 32.2% had hypertension. Their dyspnea levels were mild, anxiety levels were moderate, depression levels were high, and immunosuppressive treatment compliance levels were slightly above-average. According to the correlation analysis results, dyspnea was associated with anxiety and depression (p < 0.05). As depression increased, immunosuppressive treatment compliance decreased, and the correlation between the two variables was statistically significant (p < 0.05).

Conclusion

In this study, as the severity of dyspnea experienced by LTRs increased, the severity of their anxiety and depression also increased. Additionally, there was an inverse correlation between depression and immunosuppressive treatment compliance. LTRs demonstrated insufficient adherence to their immunosuppressive drug regimens, which is very significant in terms of graft survivability. These results suggest that LTRs should be closely monitored at home.

Death attitudes in Chronic Obstructive Pulmonary Disease (COPD) patients: A mixed-methods study

Research shows the significance of death attitudes for the mental health of somatically ill people, but findings that focus on multidimensionality in processing death are scarce. Patients with Chronic Obstructive Pulmonary Disease (COPD) report shortness of breath, pain and anxiety about suffocation and high mental distress. Utilizing a mixed-methods approach from 64 hospitalized COPD patients, we examined how they cope with mortality. We conducted a narrative interview with two questions. Patients completed the Multidimensional Orientation Toward Dying and Death Inventory (MODDI-F). Findings reveal a spectrum of death-related narratives, with most patients reporting at least 3 different attitudes. The sample showed below average scores in the Rejection of One's Own Death and Dying subscale of the MODDI-F. Assessing death attitudes using two simple questions proved highly applicable in this population and may serve as a potential approach to engage patients in discussions about existential matters, as suggested in the literature.

[Experiences of Burden and Coping Strategies and their Associations with Mental Health and Well-Being in COPD - a Mixed Methods Study]

Understanding trigger and maintaining factors regarding psychiatric comorbidities in COPD is of great importance. In the presented mixed-methods study, qualitative interview data on burden experience and coping were related to psychiatric comorbidity (using PHQ-D) and quality of live (Positive Affect Negative Affect Schedulde, PANAS and Satisfaction with Life Scale, SWLS) and extended by the Freiburg Questionnaire on Coping with Illness (FKV-LIS). The two interview questions prompting narrative were 1.) "What is currently bothering you most?"; 2.) "How do you cope with your chronic disease in everyday life?" A total of 62 patients who were hospitalized due to COPD participated. The severity of physical impairment was assessed using GOLD stage and the Charlson Comorbidity Index (CCI). The interviews conducted were content analyzed and then quantified. The collected data were then compared between two groups with regard to mental distress. 13 themes of burden and 11 coping strategies were identified by content analysis. A total of 42 patients showed signs of mental distress, while 20 patients did not show signs of distress. There were no significant differences between the two groups in terms of sociodemographic characteristics and the severity of their physical symptoms. In the first interview question, the stressed group more frequently addressed issues related to death (35.7% versus 15.0%) and social stress (21.4% versus 0.0%). With respect to the second interview question, the nonstressed group was significantly more likely to mention strategies for consciously emphasizing positive emotions (70.0% versus 31.0%). In addition, higher scores on the FKV scales for depressive coping and trivialization and wishful thinking were evident in the stressed group. Quality of life and mental distress should be considered in clinical care for COPD. Interventions to influence illness perception and related coping styles are important, especially with regard to the development of a realistic and optimistic perspective on life and disease burden, as well as the inclusion of group and family therapeutic interventions.

Analysis of the relationship between perceived stress level and death anxiety in individuals with COPD

OBJECTIVES

The study aimed to investigate the relationship between perceived stress level and death anxiety in individuals with COPD.

METHOD

It was planned with a descriptive and relational screening design. It was carried out with the participation of 132 patients diagnosed with COPD. The study data were collected through Patient Information Form, Perceived Stress Scale, and Death Anxiety Scale. Descriptive statistics and multiple regression analysis were used in data analysis.

RESULTS

The COPD patients' total perceived stress scale and perceived insufficient self-efficacy and perceived stress/distress subscale mean scores were found as 32.75 ± 5.32, 15.81 ± 3.60, and 16.93 ± 2.97, respectively. The patients' Anxiety total scale mean score was determined to be 6.96 ± 3.40. A positive and statistically significant relationship was found between COPD patients' Perceived Stress total scale mean score and their Death Anxiety Scale mean score (F = 4.332, p < 0.05).

CONCLUSION

Perceived stress level of COPD patients was found to be at a high level, while their death anxiety level was determined as moderate. It was also determined that as perceived stress levels of the patients increased, their death anxiety levels also increased.

The effect of immunosuppressive therapy after liver transplantation on activities of daily living and fear of death during the COVID-19 pandemic

BACKGROUND

In our study, we aimed to investigate the effect of immunosuppressive therapy after liver transplantation on activities of daily living and fear of death during the COVID-19 pandemic.

METHODS

This study was conducted as a cross-sectional study with the participation of 213 liver transplant patients hospitalized in the liver transplant center of a university hospital. The data analysis was performed with IBM SPSS (Statistical Package for the Social Sciences) Statistics 25.

RESULTS

Katz's Activities of Daily Living (ADL) were semi-independent and the total score was 11.07 ± 1.59, and the Death Attitude Profile-Revised (DAP-R) total score was 152.23 ± 5.34. It was determined that the DAP-R score was around 150 points in the minimum and maximum score ranges of Katz ADL after liver transplantation.

CONCLUSIONS

High fear of death threatens resilience and can make patients feel lonely, helpless, sad, abandoned and stressed. Clinicians should spend more time with their patients.