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Schooren L, Oberhoff G, Schipper S, Koch A, Kroh A, Olde Damink S, Ulmer TF, Neumann UP, Alizai PH, Schmitz SM. Students and physicians differ in perception of quality of life in patients with tumors of the upper gastrointestinal tract. Sci Rep 2024; 14:9460. [PMID: 38658620 PMCID: PMC11043386 DOI: 10.1038/s41598-024-59350-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
Health-related quality of life (HRQoL) has recently gained importance as treatment options for tumors of the upper GI tract lead to improved long-term survival. HRQoL is often estimated by physicians even though their reliability and the impact of outside factors such as contact time and level of medical education is unclear. Therefore, in this study we investigated the correlation between physicians', students', and patients' assessment of HRQoL. 54 patients presenting with tumors of the upper GI tract were included and asked to fill out the standardized HRQoL questionnaires EORTC QLQ-C30 and QLQ-OG25. Attending physicians and medical students filled out the same questionnaires through estimation of patients' HRQoL. Correlation was assessed through Pearson's and Kendall's τb coefficients. Physicians' and patients' assessments correlated for one out of six of the functional and a third of the symptom scores. Students' and patients' assessments correlated for one third of the functional and two thirds of the symptom scores. Students tended to underestimate patients' symptom burden while physicians tended to overestimate it. Physicians failed to correctly assess several pathognomonic symptoms in this study. Students showed higher correlation with patients' symptoms than physicians. Even so, this adds to mounting evidence that shows the benefit of using patient-reported outcomes as a gold standard regarding HRQoL.
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Affiliation(s)
- Lena Schooren
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Grace Oberhoff
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Sandra Schipper
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
- Department of Trauma and Reconstructive Sugery, BG Klinikum Bergmanntrost, 06112, Halle, Germany
| | - Alexander Koch
- Department of Gastroenterology, Digestive Diseases and Intensive Care Medicine, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Andreas Kroh
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Steven Olde Damink
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of General-, Visceral- and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Tom F Ulmer
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of General-, Visceral- and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Ulf P Neumann
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of General-, Visceral- and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Patrick H Alizai
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
- Klinik für Allgemein- und Viszeralchirurgie, Gemeinschaftskrankenhaus Bonn, Prinz-Albert-Straße 40, 53113, Bonn, Germany
| | - Sophia M Schmitz
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.
- Department of General-, Visceral- and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
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Prihartadi AS, Impelliziere Licastro G, Pearson M, Johnson MJ, Luckett T, Swan F. Non-medical devices for chronic breathlessness: use, barriers and facilitators for patients, carers and clinicians - a scoping review. BMJ Support Palliat Care 2023; 13:e244-e253. [PMID: 34215567 DOI: 10.1136/bmjspcare-2021-002962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/10/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Non-medical devices such as the handheld fan (fan), mobility aids (wheeled walkers with seats) and inspiratory muscle training (IMT) devices offer benefits for patient management of chronic breathlessness. We examined the published evidence regarding patient, carer and clinician use of the fan, mobility aids and IMT devices for chronic breathlessness management, and the potential barriers and facilitators to day-to-day use in a range of settings. METHODS MEDLINE, Embase, Scopus, EBSCO and the Cochrane Database of Systematic Reviews were searched. Papers were imported into EndNote and Rayyan for review against a priori eligibility criteria. Outcome data relevant to use were extracted and categorised as potential barriers and facilitators, and a narrative synthesis exploring reasons for similarities and differences conducted. RESULTS Seven studies met the inclusion criteria (n=5 fan, n=2 mobility aids and n=0 IMT devices). All of the studies presented patient use of non-medical devices only. Patients found the fan easy to use at home. Mobility aids were used mainly for outdoor activities. Outdoor use for both devices were associated with embarrassment. Key barriers included: appearance; credibility; self-stigma; technical specifications. Common facilitators were ease of use, clinical benefit and feeling safe with the device. CONCLUSION The efforts of patients, carers and clinicians to adopt and use non-medical devices for the management of chronic breathlessness is impeded by lack of implementation research. Future research should improve knowledge of the barriers and facilitators to use. This would enhance understanding of how decision-making in patient-carer-clinician triads impacts on non-medical devices use for breathlessness management.
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Affiliation(s)
| | | | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Tim Luckett
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Flavia Swan
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Abdo M, Kunisaki KM, Morris A, Stosor V, Chang D, D'Souza G, Crothers K, Abdel-Maksoud M, DiGuiseppi C, Brown TT, Erlandson KM, MaWhinney S. Pulmonary Function and Quality of Life in Aging Men With and Without HIV from the Multicenter AIDS Cohort Study. AIDS Res Hum Retroviruses 2023; 39:621-632. [PMID: 37276144 PMCID: PMC10712368 DOI: 10.1089/aid.2023.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
People living with HIV have greater pulmonary function impairments and decreased health-related quality of life (HRQoL) compared to uninfected peers. We examined whether pulmonary impairment was associated with HRQoL or respiratory health status. Using Multicenter AIDS Cohort Study data (2017-2019), associations between outcomes [HRQoL (36-Item Short Form Survey) and respiratory health status (St. George's Respiratory Questionnaire)] with pulmonary impairment [diffusing capacity for carbon monoxide (DLCO) and forced expiratory volume in 1 s (FEV1), defined as <80% predicted for both] were examined. Adjusted analyses utilized linear and zero-inflated beta regression, the latter summarized by odds ratio (OR) and quotient ratios (QRs). We also considered whether the subset of adjustment variables age, HIV serostatus, or smoking modified the relationships examined. Of 1048 men, 55% had HIV, with median age 57 [interquartile range (IQR) = 48, 64] years and 1.2 (IQR = 0, 18.1) smoking pack-years. Impaired DLCO, but not impaired FEV1, was significantly associated with lower physical HRQoL [-2.71 (-4.09, -1.33); -1.46 (-3.45, 0.54), respectively]. Pulmonary impairment was associated with higher odds of any St. George's Respiratory Questionnaire (SGRQ) (total score) limitation [DLCO OR = 1.53 (1.15, 2.04); FEV1 OR = 2.48 (1.16, 5.30)] and was elevated in individuals with more severe SGRQ limitations [DLCO QR = 1.13 (0.94, 1.36); FEV1 QR = 1.27 (0.98, 1.64)]. HIV did not modify any associations examined. Age modified the DLCO and any respiratory limitation (SGRQ symptom score) association for every 10 mL CO/min/mmHg decrease in DLCO [age 30 OR = 1.03 (0.51, 2.08); age 50 OR = 1.85 (1.27, 3.85); and age 70 OR = 3.45 (2.00, 5.88)]. Similarly, age modified the DLCO and any respiratory limitation (SGRQ total score) association. FEV1 associations with SGRQ and HRQoL scores were similar across all ages. Impaired pulmonary function was associated with lower HRQoL and greater respiratory impairments. Future studies can determine if interventions aimed at preserving pulmonary function are effective in improving HRQoL and respiratory health among aging men with and without HIV.
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Affiliation(s)
- Mona Abdo
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ken M. Kunisaki
- Pulmonary Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Alison Morris
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Valentina Stosor
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dong Chang
- Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomed Research Institute at Harbor-University of California Los Angeles Medical Center, Torrance, California, USA
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kristina Crothers
- Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Healthcare System, University of Washington, Seattle, Washington, USA
| | - Madiha Abdel-Maksoud
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kristine M. Erlandson
- Division of Infectious Disease, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Samantha MaWhinney
- Department of Biostatistics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Yin C, Udrescu M, Gupta G, Cheng M, Lihu A, Udrescu L, Bogdan P, Mannino DM, Mihaicuta S. Fractional Dynamics Foster Deep Learning of COPD Stage Prediction. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2203485. [PMID: 36808826 PMCID: PMC10131808 DOI: 10.1002/advs.202203485] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 01/03/2023] [Indexed: 05/28/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. Current COPD diagnosis (i.e., spirometry) could be unreliable because the test depends on an adequate effort from the tester and testee. Moreover, the early diagnosis of COPD is challenging. The authors address COPD detection by constructing two novel physiological signals datasets (4432 records from 54 patients in the WestRo COPD dataset and 13824 medical records from 534 patients in the WestRo Porti COPD dataset). The authors demonstrate their complex coupled fractal dynamical characteristics and perform a fractional-order dynamics deep learning analysis to diagnose COPD. The authors found that the fractional-order dynamical modeling can extract distinguishing signatures from the physiological signals across patients with all COPD stages-from stage 0 (healthy) to stage 4 (very severe). They use the fractional signatures to develop and train a deep neural network that predicts COPD stages based on the input features (such as thorax breathing effort, respiratory rate, or oxygen saturation). The authors show that the fractional dynamic deep learning model (FDDLM) achieves a COPD prediction accuracy of 98.66% and can serve as a robust alternative to spirometry. The FDDLM also has high accuracy when validated on a dataset with different physiological signals.
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Affiliation(s)
- Chenzhong Yin
- Ming Hsieh Department of Electrical and Computer EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Mihai Udrescu
- Department of Computer and Information TechnologyPolitehnica University of Timisoara2 Vasile Parvan Blvd.Timişoara300223Romania
| | - Gaurav Gupta
- Ming Hsieh Department of Electrical and Computer EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Mingxi Cheng
- Ming Hsieh Department of Electrical and Computer EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Andrei Lihu
- Department of Computer and Information TechnologyPolitehnica University of Timisoara2 Vasile Parvan Blvd.Timişoara300223Romania
| | - Lucretia Udrescu
- Department I – Drug Analysis“Victor Babeş”University of Medicine and Pharmacy Timişoara2 Eftimie Murgu Sq.Timişoara300041Romania
| | - Paul Bogdan
- Ming Hsieh Department of Electrical and Computer EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
| | | | - Stefan Mihaicuta
- Department of PulmonologyCenter for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy2 Eftimie Murgu Sq.Timişoara300041Romania
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Kirren Q, Daste C, Foissac F, Abdoul H, Alami S, Carrier ME, Kwakkenbos L, Lefèvre-Colau MM, Rannou F, Papelard A, Roren A, Thombs BD, Mouthon L, Nguyen C. Differences in Disability Perception in Systemic Sclerosis: A Mirror Survey of Patients and Health Care Providers. J Clin Med 2023; 12:jcm12041359. [PMID: 36835895 PMCID: PMC9959687 DOI: 10.3390/jcm12041359] [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: 01/03/2023] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Differences in disability perception between patients and care providers may impact outcomes. We aimed to explore differences in disability perception between patients and care providers in systemic sclerosis (SSc). We conducted a cross-sectional internet-based mirror survey. SSc patients participating in the online SPIN Cohort and care providers affiliated with 15 scientific societies were surveyed using the Cochin Scleroderma International Classification of Functioning, Disability and Health (ICF)-65 questionnaire, including 65 items (from 0 to 10), representing 9 domains of disability. Mean differences between patients and care providers were calculated. Care providers' characteristics associated with a mean difference ≥ 2 of 10 points were assessed in multivariate analysis. Answers were analyzed for 109 patients and 105 care providers. The mean age of patients was 55.9 (14.7) years and the disease duration was 10.1 (7.5) years. For all domains of the ICF-65, care providers' rates were higher than those of patients. The mean difference was 2.4 (1.0) of 10 points. Care providers' characteristics associated with this difference were organ-based specialty (OR = 7.0 [2.3-21.2]), younger age (OR = 2.7 [1.0-7.1]) and following patients with disease duration ≥5 years (OR = 3.0 [1.1-8.7]). We found systematic differences in disability perception between patients and care providers in SSc.
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Affiliation(s)
- Quentin Kirren
- UFR de Médecine, Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
| | - Camille Daste
- UFR de Médecine, Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
- INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Université Paris Cité, 75004 Paris, France
| | - Frantz Foissac
- Unité de Recherche Clinique—Centre d’Investigation Clinique Paris Descartes Necker/Cochin, Hôpital Tarnier, 75014 Paris, France
- EA 7323, Évaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université Paris Cité, 75014 Paris, France
| | - Hendy Abdoul
- Unité de Recherche Clinique—Centre d’Investigation Clinique Paris Descartes Necker/Cochin, Hôpital Tarnier, 75014 Paris, France
| | - Sophie Alami
- Cabinet d’Études Sociologiques Interlis, 75006 Paris, France
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Linda Kwakkenbos
- Behavioural Science Institute, Clinical Psychology, Radboud University Nijmegen, 6525 XZ Nijmegen, The Netherlands
| | - Marie-Martine Lefèvre-Colau
- UFR de Médecine, Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
- INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Université Paris Cité, 75004 Paris, France
| | - François Rannou
- UFR de Médecine, Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
- INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, Université Paris Cité, 75006 Paris, France
| | - Agathe Papelard
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
| | - Alexandra Roren
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
- INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Université Paris Cité, 75004 Paris, France
- Département Universitaire des Sciences de la Rééducation et de la Réadaptation, Faculté de Santé, Université Paris Cité, 75006 Paris, France
| | - Brett D. Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Departments of Psychiatry, McGill University, Montreal, QC H3A 1G1, Canada
- Departments of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC H3A 1G1, Canada
- Departments of Medicine, McGill University, Montreal, QC H3A 1G1, Canada
- Departments of Psychology, McGill University, Montreal, QC H3A 1G1, Canada
- Departments of Educational and Counselling Psychology, McGill University, Montreal, QC H3A 1G1, Canada
- Biomedical Ethics Unit, McGill University, Montreal, QC H3A 1G1, Canada
| | - Luc Mouthon
- UFR de Médecine, Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Service de Médecine Interne, Hôpital Cochin, AP-HP, Centre-Université de Paris, 75014 Paris, France
| | - Christelle Nguyen
- UFR de Médecine, Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
- INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, Université Paris Cité, 75006 Paris, France
- Correspondence: ; Tel.: +33-158-412-945
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Eid MA, Goldwag JL, Gray PP, Shaw RD, Ivatury SJ. Physicians perceive that ostomates have decreased quality of life but not overall health: An international survey of physicians. Colorectal Dis 2022; 24:1602-1612. [PMID: 36054070 DOI: 10.1111/codi.16289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/21/2022] [Accepted: 05/29/2022] [Indexed: 01/07/2023]
Abstract
AIM The aim of this work was to evaluate physicians' perceptions of ostomates' quality of life (QoL) and comfort of care among an international sample of physicians caring for ostomates. METHOD This was a cross-sectional survey study. We conducted a survey of primary care physicians (PCP), gastroenterologists (GI), and general surgeons (GS) from three continents using the SERMO online physician platform. We piloted the survey for content, clarity and domain development using a pilot sample of physicians from each speciality before use. We summarized responses to questions related to physician comfort of ostomate care with descriptive statistics. We conducted multiple logistic regression with the primary outcome of physician perception of ostomate QoL. RESULTS A total of 617 physicians (PCP 264, GI 176, GS 177) completed the survey representing North America, Europe and Australia similarly. The average age was 46 years and 21% were women. Ninety per cent of physicians care for an ostomate at least once per month. Eighty eight per cent had access to enterostomal nurses. Eighty two per cent of physicians believed that ostomates have decreased QoL. Forty seven per cent believed that ostomates have decreased overall health. Almost half of respondents answered incorrectly to a 'bogus question' citing fake clinical evidence supporting a negative impact of ostomies on social relationships. Increased physician comfort in ostomy care (OR 1.30, p = 0.04) and US-based physicians (OR 1.75, p = 0.01) were associated with increased odds of answering that ostomates have no decreased QoL. CONCLUSION Among a diverse international sample, most physicians believe that ostomates have decreased QoL but not overall health. Physician implicit bias, physician comfort and geographical variability account for these findings. Targeted efforts to increase physician comfort in ostomate care and establish universal best practices is needed.
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Affiliation(s)
- Mark A Eid
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,VA Outcomes Group, VA Quality Scholars Program, White River Junction VAMC, White River Junction, Virginia, USA
| | - Jenaya L Goldwag
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Philip P Gray
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Robert D Shaw
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Srinivas J Ivatury
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Department of Surgery and Perioperative Care, Dell Medical School, Austin, Texas, USA
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Hamari L, Siltanen H, Heikkilä K, Holopainen A. Experiences of fatigue among people with chronic obstructive pulmonary disease: a qualitative systematic review protocol. JBI Evid Synth 2022; 20:2559-2564. [PMID: 36065938 DOI: 10.11124/jbies-21-00321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this review is to explore the experiences of adults with chronic obstructive pulmonary disease living with fatigue. INTRODUCTION Chronic obstructive pulmonary disease is an incurable disease that causes multiple physical, social, and psychological burdens to those affected as well as their caregivers. One symptom that affects the quality of life of people with chronic obstructive pulmonary disease is fatigue. However, the experiences of fatigue disclosed by people with chronic obstructive pulmonary disease have not been widely documented in previous reviews. The findings of this review will provide insights into how people with chronic obstructive pulmonary disease experience fatigue, which will be useful for developing, targeting, and implementing needs-based counseling interventions to help them deal with fatigue and maintain functioning. INCLUSION CRITERIA This review will consider studies that include adults (>18 years) with chronic obstructive pulmonary disease at any stage, and that focus on the experiences of fatigue in any context, including health services (in- and out-patient), community, work, leisure, and home. METHODS MEDLINE, CINAHL, PsycINFO, Academic Search Premier, Web of Science, Medic, OpenGrey, and ProQuest Dissertation and Theses will be searched for relevant published and unpublished literature with no restrictions on publication date. Study selection, quality appraisal, and data extraction will be conducted by 2 independent reviewers. Eligible studies will be evaluated using the JBI critical appraisal tool for qualitative research. Findings will be pooled using the JBI method of meta-aggregation, and a level of credibility will be assigned to the findings. The findings will be graded according to the ConQual approach for establishing confidence in findings. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021242227.
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Affiliation(s)
- Lotta Hamari
- Nursing Research Foundation, Helsinki, Finland.,Department of Nursing Science, University of Turku, Turku, Finland.,Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
| | - Hannele Siltanen
- Nursing Research Foundation, Helsinki, Finland.,Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
| | - Kristiina Heikkilä
- Nursing Research Foundation, Helsinki, Finland.,Department of Nursing Science, University of Turku, Turku, Finland.,Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
| | - Arja Holopainen
- Nursing Research Foundation, Helsinki, Finland.,Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
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Discussing prognosis and the end of life with patients with advanced cancer or COPD: A qualitative study. PLoS One 2022; 17:e0274201. [PMID: 36084060 PMCID: PMC9462714 DOI: 10.1371/journal.pone.0274201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives To explore patients’ experiences and recommendations for discussions about their prognosis and end of life with their physicians. Methods Patients with advanced cancer or advanced chronic obstructive pulmonary disease (COPD) were enrolled in qualitative interviews, which were analyzed with a phenomenological and thematic approach. Results During interviews with fourteen patients (median age 64 years), we identified the following themes for discussion about prognosis and the end of life: topics discussed, the timing, the setting, physician–patient relationship, responsibilities for clinicians, and recommendations. Patients preferred the physician to initiate such discussion, but wanted to decide about its continuation and content. The discussions were facilitated by an established physician–patient relationship or attendance of relatives. Patients with cancer had had discussions about prognosis at rather clear-cut moments of deterioration than patients with COPD. Patients with COPD did not consider end-of-life discussions a responsibility of the pulmonologist. Patients recommended an understandable message, involvement of relatives or other clinicians, sufficient time, and sensitive non-verbal communication. Conclusions Patients appreciated open, sensitive, and negotiable discussions about prognosis and the end of life. Practice implications Patients’ recommendations could be used for communication training. Possible differences in the need for such discussions between patients with cancer or COPD warrant further research.
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9
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Kochovska S, Currow D, Chang S, Johnson M, Ferreira D, Morgan D, Olsson M, Ekström M. Persisting breathlessness and activities reduced or ceased: a population study in older men. BMJ Open Respir Res 2022; 9:9/1/e001168. [PMID: 35606021 PMCID: PMC9125752 DOI: 10.1136/bmjresp-2021-001168] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Breathlessness is debilitating and increases in prevalence with age, with people progressively reducing their everyday activities to ‘self-manage’ it. This study aimed to evaluate the impact of breathlessness on function in terms of activities that have been reduced or ceased (‘compromised’) in older men. Methods A cross-sectional postal survey of Swedish 73-year-old man in the VAScular and Chronic Obstructive Lung disease study self-reporting on demographics, breathlessness (modified Medical Research Council (mMRC) scale, Dyspnoea-12, Multidimensional Dyspnea Scale) and its duration, anxiety/depression (Hospital Anxiety and Depression Scale), performance status (WHO Performance Status), everyday activities reduced/ceased and exertion. Results 148/828 (17.9%) respondents reported breathlessness (mMRC >2), of whom 51.9% had reduced/ceased activities compared with 9.6% who did not. Physical activity was the most common activity reduced/ceased (48.0%) followed by sexual activity (41.2%) and social activities (37.8%). Of 16.0% of respondents with mMRC 3–4 talking on the phone was affected compared with only 2.9% of respondents with mMRC 2. Worsening breathlessness was associated with increasingly sedentary lifestyles and more limited function, those reporting reduced/ceased activities had an associated increase in reporting anxiety and depression. In adjusted analyses, breathlessness was associated with increased likelihood of activities being ceased overall as well as physical and sexual activities being affected separately. Conclusion Worsening breathlessness was associated with decreasing levels of self-reported physical activity, sexual activity and function. Overall, the study showed that people with persisting breathlessness modify their lifestyle to avoid it by reducing or ceasing a range of activities, seeking to minimise their exposure to the symptom.
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Affiliation(s)
- Slavica Kochovska
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sungwon Chang
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Miriam Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Diana Ferreira
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Deidre Morgan
- Palliative and Supportive Services, RePaDD, Flinders University, Adelaide, South Australia, Australia
| | - Max Olsson
- Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Magnus Ekström
- Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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10
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Luckett T, Roberts M, Smith T, Garcia M, Dunn S, Swan F, Ferguson C, Kochovska S, Phillips JL, Pearson M, Currow DC, Johnson MJ. Implementing the battery-operated hand-held fan as an evidence-based, non-pharmacological intervention for chronic breathlessness in patients with chronic obstructive pulmonary disease (COPD): a qualitative study of the views of specialist respiratory clinicians. BMC Pulm Med 2022; 22:129. [PMID: 35387636 PMCID: PMC8985391 DOI: 10.1186/s12890-022-01925-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/25/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction The battery-operated hand-held fan (‘fan’) is an inexpensive and portable non-pharmacological intervention for chronic breathlessness. Evidence from randomised controlled trials suggests the fan reduces breathlessness intensity and improves physical activity in patients with a range of advanced chronic conditions. Qualitative data from these trials suggests the fan may also reduce anxiety and improve daily functioning for many patients. This study aimed to explore barriers and facilitators to the fan’s implementation in specialist respiratory care as a non-pharmacological intervention for chronic breathlessness in patients with chronic obstructive pulmonary disease (COPD). Methods A qualitative approach was taken, using focus groups. Participants were clinicians from any discipline working in specialist respiratory care at two hospitals. Questions asked about current fan-related practice and perceptions regarding benefits, harms and mechanisms, and factors influencing its implementation. Analysis used a mixed inductive/deductive approach. Results Forty-nine participants from nursing (n = 30), medical (n = 13) and allied health (n = 6) disciplines participated across 9 focus groups. The most influential facilitator was a belief that the fan’s benefits outweighed disadvantages. Clinicians’ beliefs about the fan’s mechanisms determined which patient sub-groups they targeted, for example anxious or palliative/end-stage patients. Barriers to implementation included a lack of clarity about whose role it was to implement the fan, what advice to provide patients, and limited access to fans in hospitals. Few clinicians implemented the fan for acute-on-chronic breathlessness or in combination with other interventions. Conclusion Implementation of the fan in specialist respiratory care may require service- and clinician-level interventions to ensure it is routinely recommended as a first-line intervention for chronic breathlessness in patients for whom this symptom is of concern, regardless of COPD stage.
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Affiliation(s)
- Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Building 10, Level 3, 235 Jones St, Ultimo, Sydney, NSW, 2007, Australia.
| | - Mary Roberts
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, NSW, Australia.,Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Sydney, NSW, Australia.,The University of Sydney at Westmead Hospital, Sydney, NSW, Australia
| | - Tracy Smith
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, NSW, Australia.,The University of Sydney at Westmead Hospital, Sydney, NSW, Australia
| | - Maja Garcia
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Building 10, Level 3, 235 Jones St, Ultimo, Sydney, NSW, 2007, Australia
| | - Sarah Dunn
- Respiratory Medicine Clinic, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Flavia Swan
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston Upon Hull, Yorkshire, UK
| | - Caleb Ferguson
- Western Sydney Nursing & Midwifery Research Centre, Blacktown Clinical & Research School, Western Sydney Local Health District, Western Sydney University, Blacktown Hospital, Sydney, NSW, Australia
| | - Slavica Kochovska
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Building 10, Level 3, 235 Jones St, Ultimo, Sydney, NSW, 2007, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Building 10, Level 3, 235 Jones St, Ultimo, Sydney, NSW, 2007, Australia.,School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston Upon Hull, Yorkshire, UK
| | - David C Currow
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Building 10, Level 3, 235 Jones St, Ultimo, Sydney, NSW, 2007, Australia.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston Upon Hull, Yorkshire, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston Upon Hull, Yorkshire, UK
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11
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D'Urzo AD, Singh D, Donohue JF, Chapman KR, Wise RA. Aclidinium bromide/formoterol fumarate as a treatment for COPD: an update. Expert Rev Respir Med 2021; 15:1093-1106. [PMID: 34137664 DOI: 10.1080/17476348.2021.1920403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Aclidinium/formoterol is a long-acting muscarinic antagonist (LAMA) and long-acting β2-agonist (LABA) dual bronchodilator used as a maintenance treatment for patients with chronic obstructive pulmonary disease (COPD). The efficacy of aclidinium/formoterol has been demonstrated consistently in patients with moderate-to-severe COPD versus placebo and monocomponents, with a comparable safety profile.Areas covered: This review examines recent research findings that expand our understanding of the impact of aclidinium/formoterol on the burden of COPD. Reviewed outcomes include improvements in lung function, respiratory symptoms, health-related quality of life, exercise tolerance, exacerbation rates, and clinically important deteriorations. In addition, the reported cardiovascular safety of aclidinium and current LAMA/LABA treatment recommendations are discussed.Expert opinion: Aclidinium/formoterol reduces disease burden in patients with COPD, including those that are treatment-naïve, without a significant increase in safety risk compared with monotherapies. Furthermore, evidence supports an improvement in lung function over a 24-hour period with aclidinium/formoterol treatment versus monotherapy and placebo, which may offer an advantage over some once-daily LAMA/LABA combinations. In summary, the recent evidence discussed in this review adds weight to the use of LAMA/LABA combinations as an initial therapy for certain patients newly diagnosed with COPD.
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Affiliation(s)
- Anthony D D'Urzo
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dave Singh
- Medicines Evaluation Unit, Manchester University NHS Foundations Trust, University of Manchester, Manchester, UK
| | - James F Donohue
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina Pulmonary Critical Medicine, Chapel Hill, NC, USA
| | - Kenneth R Chapman
- Asthma and Airway Center, University Health Network, Toronto, ON, Canada
| | - Robert A Wise
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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12
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Identifying and Filling Unanticipated Critical Gaps in Care. Chest 2021; 158:2241-2242. [PMID: 33280734 DOI: 10.1016/j.chest.2020.08.2085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/20/2020] [Indexed: 11/23/2022] Open
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13
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Liu S, Lai J, Wu L, Guo X. Chinese Medicine for Chronic Obstructive Pulmonary Disease: A Pilot Study on Patient Preferences. Patient Prefer Adherence 2021; 15:1529-1535. [PMID: 34267508 PMCID: PMC8275201 DOI: 10.2147/ppa.s316872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The patient's preference plays an important role in clinical practice. There currently is no available evidence regarding the perception and attitudes of patients with chronic obstructive pulmonary disease (COPD) towards the use of Chinese medicine (CM) approaches. This study was designed to explore preferences and factors associated with CM among COPD patients. PATIENTS AND METHODS A pilot survey was conducted among COPD patients using a structured, pre-tested questionnaire. The perceptions of CM therapies (including herbal medicine, non-pharmacotherapies), and expected clinical outcomes were investigated based on patient preference. Factors associated with preference of treatment scenarios were estimated in order of importance. RESULTS Thirty patients were enrolled in the survey, including 27 males and 3 females. Two-thirds of the patients preferred integrative Chinese and Western medicine for the treatment of COPD. Chinese patent medicines and CM decoction therapy were more popular than CM injections. The preferred non-drug therapy was point application, followed by acupuncture, Tai chi, or Qigong. More than 70% of patients reported that important clinical outcomes were improvements in lung function (77%) and dyspnea, cough, and sputum symptoms (73%), followed by exercise endurance (50%). Besides clinical efficacy, costs and side effects were also important factors for treatment selection. CONCLUSION This pilot study showed that Chinese patent medicine and CM decoctions were preferred options for complementary medicines to combine with routine pharmacotherapy for COPD treatment according to the patients' preferences. The improvement of dyspnea, cough symptoms, and lung function was the most desired clinical outcomes for patients. Quicker symptom relief, lower costs, and fewer side effects were key attributes for the treatment selection. Further research with a larger sample size is needed to definitively address the comprehensive conclusion.
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Affiliation(s)
- Shaonan Liu
- Evidence-based Medicine & Clinical Research Service Group, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, Guangdong Province, People’s Republic of China
| | - Jiaqi Lai
- Evidence-based Medicine & Clinical Research Service Group, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, Guangdong Province, People’s Republic of China
| | - Lei Wu
- Respiratory Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, Guangdong Province, People’s Republic of China
| | - Xinfeng Guo
- Evidence-based Medicine & Clinical Research Service Group, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, Guangdong Province, People’s Republic of China
- Correspondence: Xinfeng Guo Evidence-based Medicine & Clinical Research Service Group, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No. 111, Dade Road, Guangzhou, People’s Republic of China, 510120Tel +8613678906862 Email
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14
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Huang C, Kochovska S, Currow DC. Letter in Response to Grobler AC, Lee K. Intention-To-Treat Analyses for Randomized Controlled Trials in Hospice/Palliative Care Enhanced by Principled Methods to Handle Missing Data. J Pain Symptom Manage 2020; 60:e30-e31. [PMID: 32663614 DOI: 10.1016/j.jpainsymman.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Chao Huang
- Hull York Medical School, University of Hull, Hull, England
| | - Slavica Kochovska
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia; Wolfson Palliative Care Research Centre, University of Hull, Hull, England.
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15
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Zimmerman DL, Min DJ, Davis-Collins A, DeBlieux P. Treating Patients As People: What Do Hospital Patients Want Clinicians to Know About Them As a Person? J Patient Exp 2020; 7:270-274. [PMID: 32851151 PMCID: PMC7427369 DOI: 10.1177/2374373519826244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background There is little understanding or focus on the patient's personal communicative perspective during their experience of clinical treatment. An exploratory study and a follow-up study were conducted at a large safety net hospital to determine whether and what patients wanted clinicians to know more about them as a person. Study Design A convenience sample of 230 patients was selected from 9 different clinical units within the hospital for exploratory interviews to determine whether patients wanted their clinical team to know about them as a person. Based on these findings, additional personal preference data of patients were collected from a census sample of 387 patients selected from 2 intensive care unit units and 2 medical-surgical units. Findings The majority of patients in the exploratory study reported they wanted to tell their doctors/nurses some personal information about themselves, thought doctors/nurses could provide better care to them if they knew more about them as a person, and that communication between themselves and their doctors/nurses would improve if they knew more about them as a person. The follow-up study found that a majority of patients preferred that their clinicians call them by their first name and identified specific personal information they wanted to share with the clinical care team. The data also showed a meaningful number of patients who did not want to share this information with others. This split in patient preferences is an important reminder that being aware of personal preferences of patients does not necessarily mean an invitation to increase intimacy in all clinician-patient communications.
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Affiliation(s)
- Donald L Zimmerman
- Healthcare Management Program, University of New Orleans, New Orleans, LA, USA
| | - Dong-Jun Min
- Department of Management and Marketing, University of New Orleans, New Orleans, LA, USA
| | | | - Peter DeBlieux
- University Medical Center, New Orleans, LA, USA.,Health Sciences Center, Louisiana State University, Baton Rouge, LA, USA
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16
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Kochovska S, Chang S, Morgan DD, Ferreira D, Sidhu M, Saleh Moussa R, Johnson MJ, Ekström M, Currow DC. Activities Forgone because of Chronic Breathlessness: A Cross-Sectional Population Prevalence Study. Palliat Med Rep 2020; 1:166-170. [PMID: 34223472 PMCID: PMC8241375 DOI: 10.1089/pmr.2020.0083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Chronic breathlessness is a prevalent disabling syndrome affecting many people for years. Identifying the impact of chronic breathlessness on people's activities in the general population is pivotal for designing symptom management strategies. Objective: This study aimed to evaluate the association between chronic breathlessness and activities respondents identify can no longer be undertaken (“activities forgone”). Design: This population-based cross-sectional online survey used a market research company's database of 30,000 registrants for each sex, generating the planned sample size—3000 adults reflecting Australia's 2016 Census by sex, age group, state of residence, and rurality. Setting/Subjects: The population of focus (n = 583) reported a modified Medical Research Council (mMRC) breathlessness scale ≥1 and experienced this breathlessness for ≥3 months. Measurements: Activities forgone were categorized by mMRC using coding derived from the Dyspnea Management Questionnaire domains. Activities were classified as “higher/lower intensity” using Human Energy Expenditure scale. Results: Respondents were male 50.3%; median age 50.0 (IQR 29.0); with 66% living in metropolitan areas; reporting 1749 activities forgone. For people with mMRC 1 (n = 533), 35% had not given up any activity, decreasing to 9% for mMRC 2 (n = 38) and 3% for mMRC 3–4 (n = 12). Intense sport (e.g., jogging and bike riding) was the top activity forgone: 42% (mMRC 1), 32% (mMRC 2), and 36% (mMRC 3–4). For respondents with mMRC 3–4, the next most prevalent activities forgone were “sexual activities” (14%), “lower intensity sports” (11%), and “other activities” (11%). Conclusions: People progressively reduce a wide range of activities because of their chronic breathlessness.
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Affiliation(s)
- Slavica Kochovska
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,Australian national Palliative Care Clinical Studies Collaborative, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Sungwon Chang
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,Australian national Palliative Care Clinical Studies Collaborative, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Deidre D Morgan
- Flinders University, Palliative and Supportive Services, RePaDD, Bedford Park, South Australia, Australia
| | - Diana Ferreira
- Flinders University, Palliative and Supportive Services, Bedford Park, South Australia, Australia
| | - Manraaj Sidhu
- Australian national Palliative Care Clinical Studies Collaborative, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Rayan Saleh Moussa
- Cancer Symptom Trials, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, University of Hull, Hull, United Kingdom
| | - Magnus Ekström
- Division of Respiratory Medicine & Allergology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,Australian national Palliative Care Clinical Studies Collaborative, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,Wolfson Palliative Care Research Centre, University of Hull, Hull, United Kingdom
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17
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Dekhuijzen PNR, Hass N, Liu J, Dreher M. Daily Impact of COPD in Younger and Older Adults: Global Online Survey Results from over 1,300 Patients. COPD 2020; 17:419-428. [PMID: 32635760 DOI: 10.1080/15412555.2020.1788526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The daily impact of chronic obstructive pulmonary disease (COPD) on younger patients is often underappreciated. To assess this, we investigated the disease burden experienced by younger and older patients. A panel of questions was developed in conjunction with the European Federation of Allergy and Airways Diseases Patients' Associations and Boehringer Ingelheim. The online survey was conducted by Instar Research. Data were collected from eight countries in Europe, plus China, Japan and the United States. All patients were receiving COPD maintenance therapy. Patients were stratified by age (45-54, 55-64, ≥65 years). Data were analyzed from 1,375 patients from Europe (925), China (150), Japan (100) and the US (200); 365 were aged 45-54, 440 aged 55-64, and 570 aged ≥65 years. Mean age was 61.8 years; 771 (56%) were male. A significantly higher proportion of patients aged 45-54 years reported "poor" or "very poor" wellbeing (35% vs. 28%; p < 0.05) and "high impact" on 8 of the 11 daily activities and requirements for adjusting activities assessed (all p < 0.05), compared with patients aged ≥65 years. Significantly more patients aged 45-54 versus ≥65 years associated their COPD with feeling "anxious", "stressed", "sad", or "overwhelmed" (all p < 0.05). Younger patients with COPD reported a higher impact on their daily activities, wellbeing and requirement for adjusting their activities due to their symptoms than older patients. Our findings highlight the importance of optimizing treatment for younger patients with COPD and suggest that clinicians should not overlook the burden of disease in these patients.
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Affiliation(s)
| | - Nicole Hass
- European Federation of Allergy and Airways Diseases Patients' Associations (EFA) representative, Brussels, Belgium
| | - Jinming Liu
- Department of Pulmonary Function Test/Department of Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen University, Aachen, Germany
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18
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Contoli M, Rogliani P, Di Marco F, Braido F, Corsico AG, Amici CA, Piro R, Sarzani R, Lessi P, Scognamillo C, Scichilone N, Santus P. Satisfaction with chronic obstructive pulmonary disease treatment: results from a multicenter, observational study. Ther Adv Respir Dis 2020; 13:1753466619888128. [PMID: 31760881 PMCID: PMC6878607 DOI: 10.1177/1753466619888128] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Understanding the level of patients’ satisfaction with treatment and its determinants have the potential to impact therapeutic management and clinical outcome in chronic conditions such as chronic obstructive pulmonary disease (COPD). Methods: A national, multicenter, longitudinal, observational study of COPD from 20 Italian pulmonary centers to explore patients’ satisfaction to treatment [assessed by the Treatment Satisfaction Questionnaire, 9 items (TSQM-9)] and association with clinical parameters [including dyspnea score, COPD Assessment Test (CAT) score, exacerbation rate], adherence to treatment [Morisky Medication-Taking Adherence Scale (MMAS-4)], illness perception [evaluated by Brief Illness Perception Questionnaire (B-IPQ)] in a 1-year follow up. Results: A total of 401 COPD patients were enrolled [69.4% group B Global Initiative for COPD (GOLD), considering 366 patients with available GOLD 2017 classification at enrollment]. At enrollment, satisfaction with treatment was moderate, being TSQM-9 mean scores for effectiveness 64.2 [95% confidence interval (CI) 62.5–65.9], for convenience 75.8 (95% CI 74.2–77.3), and for global satisfaction 65.7 (95% CI 64.0–67.4). Global satisfaction was negatively associated with disease perception (β = −0.4709, p < 0.0001), and grade of dyspnea (β = −4.2564, p = 0.009). Satisfaction with treatment was lower in patients with poor compared with optimal adherence to treatment (β = −4.5608, p = 0.002). Changes in inhalation regimens during follow up did not modify the satisfaction with treatment. Conclusions: The results of this real-life study showed that the patients’ satisfaction with treatments is only moderate in COPD. A high grade of patients’ satisfaction is associated mainly with a low perception of the disease, high adherence to treatment and lower level of dyspnea. Trial Registration: Clinicaltrials.gov identifier: NCT02689492 The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Marco Contoli
- Department of Medical Sciences, University of Ferrara, Emilia-Romagna, Italy
| | - Paola Rogliani
- Department of Experimental Medicine, University of Rome 'Tor Vergata,' Rome, Italy
| | - Fabiano Di Marco
- Department of Health Science, Università di Milano, Bergamo, Italy
| | - Fulvio Braido
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Angelo G Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | | | - Roberto Piro
- Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy
| | - Riccardo Sarzani
- Internal Medicine and Geriatrics, Università Politecnica delle Marche and IRCCS-INRCA, Ancona, Italy
| | | | | | | | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), Università di Milano, Division of Respiratory Diseases, 'L. Sacco' Hospital, Via G.B. Grassi 74, Milan 20157, Italy
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19
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Vogelmeier CF, Román-Rodríguez M, Singh D, Han MK, Rodríguez-Roisin R, Ferguson GT. Goals of COPD treatment: Focus on symptoms and exacerbations. Respir Med 2020; 166:105938. [PMID: 32250871 DOI: 10.1016/j.rmed.2020.105938] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/18/2020] [Indexed: 12/21/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is currently a leading cause of death worldwide, and its burden is expected to rise in the coming years. Common COPD symptoms include dyspnea, cough and/or sputum production. Some patients may experience acute worsening of symptoms (known as an exacerbation), and therefore require additional therapy. Exacerbations are mainly triggered by respiratory infections and environmental factors. Healthcare professionals face many challenges in COPD management, including the heterogeneity of the disease and under-reporting of symptoms. The authors review these challenges and provide recommendations for the best methods to assess COPD. The goals of COPD treatment include recognising the impact that both symptoms and exacerbations have on patients' lives when considering optimal patient-focused management. The review discusses the need for COPD management strategies to include both pharmacologic and non-pharmacologic approaches and provides recommendations for monitoring treatment outcomes and adjusting management strategies accordingly. Novel treatment strategies including precision medicine and point-of-care testing are also discussed.
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Affiliation(s)
- Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps University of Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany.
| | - Miguel Román-Rodríguez
- Son Pisà Primary Health Care Centre, Instituto de Investigación Sanitaria de Las Islas Baleares (IdISBa), Palma de Mallorca, Spain
| | - Dave Singh
- Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | | | - Gary T Ferguson
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, USA
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20
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Rodriguez Hermosa JL, Fuster Gomila A, Puente Maestu L, Amado Diago CA, Callejas González FJ, Malo De Molina Ruiz R, Fuentes Ferrer ME, Álvarez Sala-Walther JL, Calle Rubio M. Compliance and Utility of a Smartphone App for the Detection of Exacerbations in Patients With Chronic Obstructive Pulmonary Disease: Cohort Study. JMIR Mhealth Uhealth 2020; 8:e15699. [PMID: 32191213 PMCID: PMC7118552 DOI: 10.2196/15699] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/14/2019] [Accepted: 12/16/2019] [Indexed: 12/31/2022] Open
Abstract
Background In recent years, mobile health (mHealth)–related apps have been developed to help manage chronic diseases. Apps may allow patients with a chronic disease characterized by exacerbations, such as chronic obstructive pulmonary disease (COPD), to track and even suspect disease exacerbations, thereby facilitating self-management and prompt intervention. Nevertheless, there is insufficient evidence regarding patient compliance in the daily use of mHealth apps for chronic disease monitoring. Objective This study aimed to provide further evidence in support of prospectively recording daily symptoms as a useful strategy to detect COPD exacerbations through the smartphone app, Prevexair. It also aimed to analyze daily compliance and the frequency and characteristics of acute exacerbations of COPD recorded using Prevexair. Methods This is a multicenter cohort study with prospective case recruitment including 116 patients with COPD who had a documented history of frequent exacerbations and were monitored over the course of 6 months. At recruitment, the Prevexair app was installed on their smartphones, and patients were instructed on how to use the app. The information recorded in the app included symptom changes, use of medication, and use of health care resources. The patients received messages on healthy lifestyle behaviors and a record of their cumulative symptoms in the app. There was no regular contact with the research team and no mentoring process. An exacerbation was considered reported if medical attention was sought and considered unreported if it was not reported to a health care professional. Results Overall, compliance with daily records in the app was 66.6% (120/180), with a duration compliance of 78.8%, which was similar across disease severity, age, and comorbidity variables. However, patients who were active smokers, with greater dyspnea and a diagnosis of depression and obesity had lower compliance (P<.05). During the study, the patients experienced a total of 262 exacerbations according to daily records in the app, 99 (37.8%) of which were reported exacerbations and 163 (62.2%) were unreported exacerbations. None of the subject-related variables were found to be significantly associated with reporting. The duration of the event and number of symptoms present during the first day were strongly associated with reporting. Despite substantial variations in the COPD Assessment Test (CAT), there was improvement only among patients with no exacerbation and those with reported exacerbations. Nevertheless, CAT scores deteriorated among patients with unreported exacerbations. Conclusions The daily use of the Prevexair app is feasible and acceptable for patients with COPD who are motivated in their self-care because of frequent exacerbations of their disease. Monitoring through the Prevexair app showed great potential for the implementation of self-care plans and offered a better diagnosis of their chronic condition.
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Affiliation(s)
- Juan Luis Rodriguez Hermosa
- Pulmonology Department, Hospital Clínico San Carlos, Madrid, Spain.,Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Luis Puente Maestu
- Pulmonology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Antonio Amado Diago
- Pulmonology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.,Medical Department, School of Medicine, Universidad de Cantabria, Santander, Spain
| | | | | | - Manuel E Fuentes Ferrer
- Departament of Preventive Medicine, Hospital Clínico San Carlos, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Jose Luis Álvarez Sala-Walther
- Pulmonology Department, Hospital Clínico San Carlos, Madrid, Spain.,Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Myriam Calle Rubio
- Pulmonology Department, Hospital Clínico San Carlos, Madrid, Spain.,Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Siltanen H, Aine T, Huhtala H, Kaunonen M, Vasankari T, Paavilainen E. Psychosocial issues need more attention in COPD self-management education. Scand J Prim Health Care 2020; 38:47-55. [PMID: 32024406 PMCID: PMC7054946 DOI: 10.1080/02813432.2020.1717087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: To find out how regularly the contents of patient education regarded as essential for COPD patients' self-management are provided by healthcare professionals in specialised healthcare (SHC) and primary healthcare (PHC) in Finland.Design: A cross-sectional study based on an e-questionnaire with 42 items on the content of self-management education of COPD patients.Setting: The study sample included all public SHC units with pulmonary outpatient clinics (n = 29) and nine out of 160 health centres in Finland.Subjects: 83 doctors and 162 nurses.Main outcome measures: The respondents' answers on how regularly they included the contents regarded as essential for COPD patients' self-management in their education of COPD patients.Results: COPD patients were educated regularly on medical issues regarding COPD treatment, such as smoking cessation, exercise and pharmacological treatment. However, issues vital for coping with the disease, such as psychological well-being, stress management or fatigue, were often ignored. Patient education in SHC seemed to be more systematic than education in PHC. The education provided by the asthma/COPD nurses (n = 70) was more systematic than the education provided by the other nurses (n = 84).Conclusion: Healthcare professionals' continuous education should cover not only the medical but also the psychosocial aspects of coping with COPD. The role of doctors and nurses should be considered to ensure that there is no gap in COPD patients' education. Training asthma/COPD nurses and promoting specialised nurse-led asthma/COPD clinics in primary care could be beneficial while improving practices of patient education that enhance patients' ability to cope with the disease.KEY POINTSIssues vital for coping with chronic obstructive pulmonary disease (COPD), such as psychological well-being, stress and fatigue, are irregularly included in self-management education both in primary and specialised healthcare.Patient education provided by asthma/COPD nurses is more regular than patient education provided by other nurses.The distribution of work between doctors and nurses should be considered to ensure that there is no gap in COPD patients' education.
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Affiliation(s)
- Hannele Siltanen
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland;
- Nursing Research Foundation, Helsinki, Finland;
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Affiliated Group, Helsinki, Finland;
- CONTACT Hannele Siltanen Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Tiina Aine
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland;
| | - Heini Huhtala
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland;
| | - Marja Kaunonen
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland;
- Pirkanmaa Hospital District, Tampere, Finland;
| | - Tuula Vasankari
- Division of Medicine, Department of Pulmonary Disease and Clinical Allergology, University of Turku, Turku, Finland;
- Finnish Lung Health Association (FILHA), Helsinki, Finland;
| | - Eija Paavilainen
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland;
- Etelä-Pohjanmaa Hospital District, Seinäjoki, Finland
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Mooren K, van der Linden G, Pool K, Engels Y. The Attitudes of Pulmonologists Regarding Smoking Behavior of Their Patients with Advanced COPD: A Qualitative Research. Int J Chron Obstruct Pulmon Dis 2019; 14:2673-2679. [PMID: 31819400 PMCID: PMC6890171 DOI: 10.2147/copd.s216274] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 09/23/2019] [Indexed: 12/15/2022] Open
Abstract
Background Patients with diseases linked with smoking, such as COPD, report a health-related stigma on their smoking behavior, which is related to a poorer quality of life and psychological distress. According to patients with COPD, health-care professionals sometimes reinforce the sense of stigma. However, little is known about the physicians’ attitudes on this topic towards the patient with COPD. Purpose To explore attitudes of pulmonologists regarding the smoking behavior of their patients with COPD and if (and to what extent) a stigma is present in their attitudes towards their smoking patients. Patients and methods Eighteen pulmonologists were interviewed using a semi-structured guide with prespecified topics. The interview transcripts were coded using Atlas.ti. Analysis of data from these interviews was performed using conventional content analysis. Results We identified three themes: attitudes towards smoking in general, the interaction between patient and physician, and smoking cessation. All participants said patients are not fully responsible for their smoking behavior. Contrarily, smoking was also seen as a free choice by most physicians. Moreover, smoking cessation was mostly seen as the responsibility of the patient. Feelings of powerlessness, frustration and compassion were reported in the guidance of patients with COPD. Conclusion The results of this study show an ambivalent attitude of pulmonologists regarding the smoking behavior of their patients with COPD. The outcomes of this study can form a base for further research and can be used as insights for interventions that aim to raise awareness of physicians’ own attitudes and increase the quality of physician–patient communication.
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Affiliation(s)
- K Mooren
- Department of Lung Disease, Spaarne Gasthuis, Haarlem, Noord-Holland, the Netherlands
| | - Ggh van der Linden
- Department of Internal Medicine, ETZ, Tilburg, Noord-Brabant, the Netherlands
| | - K Pool
- Department of Lung Disease, Rode Kruis Ziekenhuis, Beverwijk, Noord-Holland, the Netherlands
| | - Y Engels
- Department of Anaesthesiology, Pain and Palliative Care, RadboudUMC, Nijmegen, Gelderland, the Netherlands
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Valipour A, Tamm M, Kociánová J, Bayer V, Sanzharovskaya M, Medvedchikov A, Haaksma-Herczegh M, Mucsi J, Fridlender Z, Toma C, Belevskiy A, Matula B, Šorli J. Improvement In Self-Reported Physical Functioning With Tiotropium/Olodaterol In Central And Eastern European COPD Patients. Int J Chron Obstruct Pulmon Dis 2019; 14:2343-2354. [PMID: 31632003 PMCID: PMC6793952 DOI: 10.2147/copd.s204388] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 08/15/2019] [Indexed: 12/14/2022] Open
Abstract
Background Reduced physical activity is associated with increased morbidity and mortality in patients with COPD. Studies suggest that treatment with the long-acting muscarinic antagonist tiotropium and the long-acting β2-agonist olodaterol increases exercise capacity. This study assessed the effects of a fixed-dose combination (FDC) of tiotropium/olodaterol (delivered via Respimat®) on physical functioning in patients with stable COPD in a “real-world setting”. Methods An international, open-label, single-arm, non-interventional study conducted in nine countries measuring changes in self-reported physical functioning in COPD patients treated with tiotropium/olodaterol 5/5 μg FDC for approximately 6 weeks. The primary endpoint was therapeutic success, defined as a minimum 10-point increase in the 10-question Physical Functioning Questionnaire (PF-10) score. Secondary endpoints included absolute change in PF-10 from Visit 1 to Visit 2, patient general condition (measured by Physician’s Global Evaluation score) and patient satisfaction with the treatment and device (assessed by Patient Satisfaction Questionnaire at the end of the study period). Results Therapeutic success was observed in 67.8% of 7218 patients (95% CI 66.7, 68.8) in the final analysis set after approximately 6 weeks of treatment with tiotropium/olodaterol. Mean change in PF-10 score between Visit 1 and Visit 2 was 16.6 points (95% CI 16.2, 17.0). Therapeutic success was 64.3% (95% CI 63.0–65.6%) in patients with infrequent (≤1) and 76.1% (95% CI 74.3–77.9%) in patients with frequent (≥2) exacerbations (p<0.0001). Patient general condition improved as indicated by an improvement in Physician’s Global Evaluation scores between visits. Most patients were very satisfied or satisfied with tiotropium/olodaterol treatment in general (81%), reported inhalation satisfaction (85%), and satisfactory handling of the device (84%). 1.3% of patients reported an investigator-defined drug-related adverse event. Conclusion Treatment with tiotropium/olodaterol led to an improvement in self-reported physical functioning in patients with COPD.
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Affiliation(s)
- Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Krankenhaus Nord - Klinik Floridsdorf, Vienna, Austria
| | - Michael Tamm
- Lung Centre/Pneumology Department, University Hospital Basel, Basel, Switzerland
| | - Jana Kociánová
- Pneumological Outpatient Department, MephaCentrum, a.s., Ostrava-Poruba, Czech Republic
| | - Valentina Bayer
- Biostatistics and Data Sciences, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | | | - Alexey Medvedchikov
- Medical Affairs Regional Center, Boehringer Ingelheim RCV GmbH & Co. KG, Vienna, Austria
| | | | | | - Zvi Fridlender
- Department of Internal Medicine, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Claudia Toma
- Department of Pneumology, Institute of Pneumatology "Marius Nasta", Bucharest, Romania.,Department Of Pneumology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Andrey Belevskiy
- Department of Pulmonology, Pirogov Russian National Research Medical University, Pletnev Hospital, Moscow, Russian Federation
| | - Bohumil Matula
- Department of Functional Diagnostics, Specialized Hospital of Saint Zoerardus, Teaching Facility of the Slovak Medical University, Nitra, Slovakia
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Burchette JE, Click IA, Johnson L, Williams SA, Morgan BT. Relationship of Patient Self-Administered COPD Assessment Test to Physician Standard Assessment of Chronic Obstructive Pulmonary Disease in a Family Medicine Residency Training Program. J Patient Cent Res Rev 2019; 6:210-215. [PMID: 31414033 DOI: 10.17294/2330-0698.1699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Assessing the global impact of chronic obstructive pulmonary disease (COPD) on a patient's life can be difficult to perform in the clinical setting due to time constraints and workflow challenges. The primary objective of this study was to compare disease impact ratings between patient self-administered COPD Assessment Test (CAT) and physician standard office assessment. This prospective study was conducted at a family medicine residency clinic in northeast Tennessee. The study included two study groups: 1) adult patients seen at the clinic during the 3-month study period with an active diagnosis of COPD, and 2) their physicians. Physicians' assessment of the impact of COPD on their patients' daily lives was compared to patients' self-administered CAT assessments. Physician assessment of COPD impact and patient assessment of CAT categories significantly differed (χ2=11.0, P=0.012). There was very poor agreement between patient and physician ratings (κ=0.003), with 42.9% of physician ratings underestimating the impact, 28.6% overestimating the impact, and 28.6% correctly estimating the impact COPD had on their patients' lives. These findings support the use of validated assessment tools to help providers understand the symptom burden for patients with COPD.
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Affiliation(s)
- Jessica E Burchette
- Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN
| | - Ivy A Click
- Department of Family Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN
| | - Leigh Johnson
- Department of Family Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN
| | - S Alicia Williams
- Department of Family Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN
| | - Brett Tyler Morgan
- Department of Family Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN
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Lunn S, Dharmagunawardena R, Lander M, Sweeney J. It's hard to talk about breathlessness: a unique insight from respiratory trainees . Clin Med (Lond) 2019; 19:344-347. [PMID: 31308122 PMCID: PMC6752249 DOI: 10.7861/clinmedicine.19-4-344] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This paper describes how difficult it can be to discuss the experience of breathlessness with patients, as identified by respiratory trainees in a psychology-led workshop. The reasons why it is considered an essential role for clinicians to facilitate conversations about patients' breathlessness are outlined within the context of the challenges of respiratory care. The benefits for both patient and clinician are described including rapport building, more focused and targeted consultations, and increasing a patient's receptivity to interventions. The value of preparing a patient to actively engage with their breathlessness management is highlighted. As a way to support clinicians to initiate talk about breathlessness, a 'five-step guide to talking' is presented.
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Affiliation(s)
- Sarah Lunn
- Whittington Health NHS Trust, London, UK
| | | | - Mark Lander
- University College London Hospitals NHS Foundation Trust, London, UK
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26
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Cheung MMY, Saini B, Smith L. 'It's a powerful message': a qualitative study of Australian healthcare professionals' perceptions of asthma through the medium of drawings. BMJ Open 2019; 9:e027699. [PMID: 31028044 PMCID: PMC6501968 DOI: 10.1136/bmjopen-2018-027699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES This study aimed to explore healthcare professionals' (HCPs') perspectives of asthma through their drawings, and their responses when viewing patients' drawings of their experiences of asthma. DESIGN A qualitative exploratory study with a purposive, convenience sample of participants. Participants were asked to first express their perspectives of asthma in a drawing, which was followed by a review of drawings made by patients with asthma. SETTING Primary and tertiary HCPs from Sydney, Australia. PARTICIPANTS Twenty-three HCPs from a range of health professions. RESULTS The HCPs illustrated their perspective of asthma through drawings which were largely biomedically framed, depicting physiological and clinical aspects of asthma. In contrast, their discussion around the patients' drawings centred on the person more than the condition. The patients' drawings triggered the HCPs to revisit their personal expectations of their patients' illness experience; prompted differing degrees of acknowledgement and empathy regarding the patient experience; and encouraged clinical reflexivity. CONCLUSIONS Our findings provide support for the educational application of patients' drawings in bringing HCPs closer to the patient lived experience. The drawings fostered deeper insight into patient perspectives of asthma and stimulated critical reflection on current healthcare practices.
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Affiliation(s)
- Melissa Mei Yin Cheung
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Bandana Saini
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Lorraine Smith
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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Carratalá-Munuera C, Arriero-Marin JM, Orozco-Beltrán D, Cuneo Amat B, Lopez-Pineda A, Soler-Cataluña JJ, Gil-Guillén VF, Quesada Rico JA. Percepción de calidad de vida en pacientes con enfermedad pulmonar obstructiva crónica en España. OPEN RESPIRATORY ARCHIVES 2019. [DOI: 10.1016/j.opresp.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Pharmacological Therapy of COPD. Chest 2018; 154:1404-1415. [DOI: 10.1016/j.chest.2018.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 11/20/2022] Open
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Gatti V, Banfi P, Centanni S, D'Antonio S, Giustini S, Piraino A, Zibellini M, Marini MG. Enlightening chronic obstructive pulmonary disease through patients' and caregivers' narratives. Int J Chron Obstruct Pulmon Dis 2018; 13:3095-3105. [PMID: 30323580 PMCID: PMC6178274 DOI: 10.2147/copd.s172214] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose The primary aim of this research was to raise awareness for COPD through real narratives of patients, caregivers, and pulmonologists. The second objective includes providing clinicians new means of caring for and treating patients with COPD. Methods Using narrative medicine, testimonies from patients, their caregivers, and clinicians were collected through an online questionnaire enriched by a narrative plot. Narrations were analyzed throughout descriptive statistics and an elaboration of recurring words and expressions. Results Throughout the project, 350 narratives were collected from 235 patients, 55 caregivers, and 60 physicians. Though a generally neutral reaction had been observed upon diagnosis, COPD had been found to have a high impact on the patients’ and caregivers’ lives. Metaphors utilized by patients and caregivers were suggestive of fear and panic unlike those utilized by clinicians who usually had a more technical approach. Smoking was a significant concern for not only patients and caregivers but also clinicians. Conclusion Physicians are therefore challenged to find new ways of communicating COPD to raise awareness on this pathology and encourage corrective habits. An important social objective should be the implementation of a health system that is able to optimize patients’ and caregivers’ lives.
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Affiliation(s)
| | - Paolo Banfi
- Fondazione Don Carlo Gnocchi IRCCS, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST San Paolo e San Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Saffi Giustini
- Italian General Practitioners' Association "SIMG", Florence, Local Health Unit of Montale, Pistoia, Italy
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Strang S, Osmanovic M, Hallberg C, Strang P. Family Caregivers' Heavy and Overloaded Burden in Advanced Chronic Obstructive Pulmonary Disease. J Palliat Med 2018; 21:1768-1772. [PMID: 30118371 DOI: 10.1089/jpm.2018.0010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Due to severe symptoms and poor prognosis in advanced cases, chronic obstructive pulmonary disease (COPD) is today seen as a palliative diagnosis. The everyday lives of patients as well as their relatives are restricted and affected by significant psychosocial problems. OBJECTIVE To obtain detailed knowledge about people's experiences, for example, transitions in relationships, responsibility, and possible changes in communication, caused by the illness. DESIGN This is a qualitative interview study using both focus group interviews and individual interviews. SETTING/SUBJECTS In total, 35 family members with personal experience of living with a person with severe COPD were interviewed. MEASUREMENTS The semistructured interviews were audio-recorded, transcribed verbatim, and analyzed with a qualitative content analysis. RESULTS Three themes emerged: (1) A restricted everyday life. The family caregivers felt confined to their own home, they had to be constantly attentive, and their lives became increasingly restricted. (2) A changed relationship. There was a shift in responsibility and their mutual communication. The family caregivers' own needs were neglected and the relationship was affected. (3) Joy through adaption. Still, caregivers strived for normality and, through gradual adaption, they could still experience joy. CONCLUSIONS Being a family caregiver is a burdensome and complex situation. Besides providing practical help, the family caregiver needs to support the ill person. Roles and communication patterns are changed. Healthcare staff must identify the needs of the family caregivers. A family caregiver who feels acknowledged and confident can support their severely ill family member.
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Affiliation(s)
- Susann Strang
- 1 Angered Hospital, Angered, Sweden.,2 Institute of Caring Sciences and Health, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Peter Strang
- 3 Department of Oncology-Pathology, Karolinska Institutet, Stockholm and Stockholms Sjukhem, Stockholm, Sweden
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Mahler DA, Cerasoli F, Della L, Rudzinski M. Internet Health Behaviors of Patients with Chronic Obstructive Pulmonary Disease and Assessment of Two Disease Websites. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2018; 5:158-166. [PMID: 30584579 DOI: 10.15326/jcopdf.5.3.2017.0173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: Little is known about patients' use of the internet to search for information about chronic obstructive pulmonary disease (COPD) and their perspectives on disease content on websites. Objectives: To determine the interests and behavior of patients with COPD who search the internet for disease information and to assess their perspectives about 2 COPD educational websites. Methods: Individuals with COPD who had registered for a consumer panel were invited electronically to participate in a survey which included general use of the internet, online health behaviors about COPD, and assessment of 2 COPD educational websites. Results: A total of 445 respondents completed the survey in 23 ± 12 minutes (72% response rate). A total of 95% reported that physicians were the primary source of information about COPD followed by internet searches about the disease (76%). The 3 major information priorities were "symptom control" (82%), "how COPD is affecting my body" (60%), and "treatments that might work better for me" (59%). Overall ratings (range, 1 - 10) were 7.4 ± 1.5 for the American Lung Association and 6.8 ±1.8 for the COPD Foundation websites. Ratings by respondents were higher for all 5 impression attributes and for 8 of 9 content attributes on the American Lung Association website compared with the COPD Foundation website. Conclusions: This report describes, for the first time, information priorities of patients with COPD about their disease and their assessment of 2 educational websites. Our survey results can be used by health care professionals to recommend online resources to their patients.
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Affiliation(s)
- Donald A Mahler
- Emeritus Professor of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.,Valley Regional Hospital, Claremont, New Hampshire
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Lewthwaite H, Effing TW, Lenferink A, Olds T, Williams MT. Improving physical activity, sedentary behaviour and sleep in COPD: perspectives of people with COPD and experts via a Delphi approach. PeerJ 2018; 6:e4604. [PMID: 29719731 PMCID: PMC5926552 DOI: 10.7717/peerj.4604] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/21/2018] [Indexed: 11/20/2022] Open
Abstract
Background Little is known about how to achieve enduring improvements in physical activity (PA), sedentary behaviour (SB) and sleep for people with chronic obstructive pulmonary disease (COPD). This study aimed to: (1) identify what people with COPD from South Australia and the Netherlands, and experts from COPD- and non-COPD-specific backgrounds considered important to improve behaviours; and (2) identify areas of dissonance between these different participant groups. Methods A four-round Delphi study was conducted, analysed separately for each group. Free-text responses (Round 1) were collated into items within themes and rated for importance on a 9-point Likert scale (Rounds 2–3). Items meeting a priori criteria from each group were retained for rating by all groups in Round 4. Items and themes achieving a median Likert score of ≥7 and an interquartile range of ≤2 across all groups at Round 4 were judged important. Analysis of variance with Tukey’s post-hoc tested for statistical differences between groups for importance ratings. Results Seventy-three participants consented to participate in this study, of which 62 (85%) completed Round 4. In Round 4, 81 items (PA n = 54; SB n = 24; sleep n = 3) and 18 themes (PA n = 9; SB n = 7; sleep n = 2) were considered important across all groups concerning: (1) symptom/disease management, (2) targeting behavioural factors, and (3) less commonly, adapting the social/physical environments. There were few areas of dissonance between groups. Conclusion Our Delphi participants considered a multifactorial approach to be important to improve PA, SB and sleep. Recognising and addressing factors considered important to recipients and providers of health care may provide a basis for developing behaviour-specific interventions leading to long-term behaviour change in people with COPD.
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Affiliation(s)
- Hayley Lewthwaite
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Tanja W Effing
- College of Medicine & Public Health, Flinders University of South Australia, Bedford Park, South Australia, Australia.,Department of Respiratory Medicine, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Anke Lenferink
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands.,Department of Health Technology and Services Research, Faculty of Behavioural Sciences, University of Twente, Enschede, Netherlands
| | - Tim Olds
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Marie T Williams
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Toh HJ, Low JA, Lim ZY, Lim Y, Siddiqui S, Tan L. Jonsen's Four Topics Approach as a Framework for Clinical Ethics Consultation. Asian Bioeth Rev 2018; 10:37-51. [PMID: 33717274 DOI: 10.1007/s41649-018-0047-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/03/2018] [Accepted: 03/05/2018] [Indexed: 01/24/2023] Open
Abstract
This was an in-depth qualitative study that looked at the reasons patients were referred to the Clinical Ethics Committee (CEC) of an acute hospital in Singapore and explore how the CEC approached cases referred. Jonsen's four topics approach was applied in the deliberative process for all cases. A comprehensive review of the case records of 28 patients referred consecutively to the CEC from 1 January 2012 to 31 December 2014 was conducted. Data and information was collated from the referral forms, patient medical records, and emails communicated among CEC members. A deductive approach to thematic analysis based on Jonsen's four topics approach was used to analyze the documents. Majority of the patients were male (94%), Chinese (76%), and above 65 years of age (41%). Ethical dilemmas surfaced due to differences in opinion regarding withholding of aggressive management (53%), withdrawing treatment (35%), and ascertaining patient's autonomy (12%). In most cases, the patients' preference on end-of-life care was unknown (82%). The main reasons for referral to the CEC were conflicts in clinical management and uncertainty about the decision-making capacity of patients. The CEC members tended to emphasize on "patient preference" more than the other quadrants in the four topics approach as they worked through each case. The Jonsen's four topics approach lays the groundwork to frame ethical dilemmas that can be easily applied in the clinical setting and is a useful tool for the CEC's teaching and discussion. Nonetheless, the approach only organizes ethical dilemmas and requires clinicians to apply own judgment in weighing ethical principles. Further studies can look into adapting the four topics approach to suit the local practices and context.
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Affiliation(s)
- Hui Jin Toh
- GeriCare@North, Khoo Teck Puat Hospital, Singapore, Singapore.,Education Research, Geriatric Education and Research Institute, Singapore, Singapore
| | - James Alvin Low
- GeriCare@North, Khoo Teck Puat Hospital, Singapore, Singapore.,Education Research, Geriatric Education and Research Institute, Singapore, Singapore.,Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Zhen Yu Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yvonne Lim
- Clinical Services, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Lawrence Tan
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
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