1 research outputs found
Do guidelines influence breathlessness management in advanced lung diseases? A multinational survey of respiratory medicine and palliative care physicians
Background
Respiratory medicine (RM) and palliative care (PC) physiciansβ management of chronic breathlessness in advanced chronic obstructive pulmonary disease (COPD), fibrotic interstitial lung disease (fILD) and lung cancer (LC), and the influence of practice guidelines was explored via an online survey.
Methods
A voluntary, online survey was distributed to RM and PC physicians via society newsletter mailing lists.
Results
450 evaluable questionnaires (348 (77%) RM and 102 (23%) PC) were analysed. Significantly more PC physicians indicated routine use (often/always) of opioids across conditions (COPD: 92% vs. 39%, fILD: 83% vs. 36%, LC: 95% vs. 76%; all pβ<β0.001) and significantly more PC physicians indicated routine use of benzodiazepines for COPD (33% vs. 10%) and fILD (25% vs. 12%) (both pβ<β0.001). Significantly more RM physicians reported routine use of a breathlessness score (62% vs. 13%, pβ<β0.001) and prioritised exercise training/rehabilitation for COPD (49% vs. 7%) and fILD (30% vs. 18%) (both pβ<β0.001). Overall, 40% of all respondents reported reading non-cancer palliative care guidelines (either carefully or looked at them briefly). Respondents who reported reading these guidelines were more likely to: routinely use a breathlessness score (Ο2β=β13.8; pβ<β0.001), use opioids (Ο2β=β12.58, pβ<β0.001) and refer to pulmonary rehabilitation (Ο2β=β6.41, pβ=β0.011) in COPD; use antidepressants (Ο2β=β6.25; pβ=β0.044) and refer to PC (Ο2β=β5.83; pβ=β0.016) in fILD; and use a handheld fan in COPD (Ο2β=β8.75, pβ=β0.003), fILD (Ο2β=β4.85, pβ=β0.028) and LC (Ο2β=β5.63; pβ=β0.018).
Conclusions
These findings suggest a need for improved dissemination and uptake of jointly developed breathlessness management guidelines in order to encourage appropriate use of existing, evidence-based therapies. The lack of opioid use by RM, and continued benzodiazepine use in PC, suggest that a wider range of acceptable therapies need to be developed and trialled