Hospitalist attitudes toward the assessment and management of dyspnea in patients with acute cardiopulmonary diseases

Abstract

Background Dyspnea is a common symptom in patients hospitalized with acute cardiopulmonary diseases. Routine assessment of dyspnea severity is recommended by clinical guidelines based on the evidence that patients are not treated consistently for dyspnea relief. Objective To evaluate attitudes and beliefs of hospitalists regarding the assessment and management of dyspnea. Design Cross-sectional survey Settings Nine hospitals in the United States. Measurements Survey questions assessed the following domains regarding dyspnea: importance in clinical care; potential benefits and challenges of implementing a standardized assessment; current approaches to assessment and how awareness of severity affects management. A five-point Likert scale was used to assess the respondent’s level of agreement; strongly agree and agree were combined into a single category. Results Of the 255 hospitalists invited to participate, 69.8% completed the survey; 77.0% agreed that dyspnea relief is an important goal when treating patients with cardiopulmonary conditions. Approximately 90% of respondents stated that awareness of dyspnea severity influences their decision to intensify treatment, to pursue additional diagnostic testing and the timing of discharge. 61.0% agreed that standardized assessment of dyspnea should be part of the vital signs and 64.6% that awareness of dyspnea severity influences their decision to prescribe opioids. Hospitalists who appreciated the importance of dyspnea in clinical practice were more likely to support the implementation of a standardized scale. Conclusions Most hospitalists believe that routine assessment of dyspnea severity would enhance their clinical decision-making and patient care. Measurement and documentation of dyspnea severity may represent an opportunity to improve dyspnea management.

Routine dyspnea assessment and documentation: Nurses’ experience yields wide acceptance

“…A survey of hospitalists, regarding only patients admitted for acute cardiopulmonary disease, suggested that the addition of dyspnea assessment would “have a significant effect on existing nursing and physician workflows” [4]. However, our data show the majority of clinical nurses readily adopted routine dyspnea measurement on all patients, finding it easy to incorporate the new documentation into their workflow.…”

“…Routine pain assessment and documentation is nearly universal; dyspnea assessment is not. Barriers to routine dyspnea documentation include concerns that it will have a deleterious effect on nursing workflow and that it will not be readily accepted by nurses [4]. The present study addresses these concerns.…”

How well do patients and providers agree on the severity of dyspnea?

“…In a recent study that evaluated the attitudes and beliefs of hospitalists regarding the assessment and management of dyspnea, we found that most hospitalists indicated that awareness of dyspnea severity influences their decision for treatment, diagnostic testing, and timing of the discharge. Moreover, whereas less than half of the respondents reported experience with standardized assessment of dyspnea severity, most stated that such data would be very useful in their practice …”

Attitude change and increased confidence with management of chronic breathlessness following a health professional training workshop: a survey evaluation

“…Attitudes were examined using questions modified from a previous survey of health professional attitudes toward assessment and management of breathlessness [26] (used and modified with permission from the authors). While the original survey assessed hospital doctors' attitudes toward dyspnoea assessment and management in patients with acute cardiopulmonary diseases [26], in our study modifications were made to align the questionnaire wording with our focus on chronic breathlessness. For example, an original survey statement was: "The patient's experience of dyspnea should be used to guide treatment decisions independent of objective measures such as respiratory rate and oxygen saturation".…”

“…In contrast, there is relatively little is known about clinician attitudes, understanding and confidence in chronic breathlessness assessment and management. Recent surveys of medical professionals concerning dyspnoea reflect positive perceptions of the value of standardised assessments in patient care (n = 255 hospital doctors [23]), but less consistent agreement about the ability of patients to rate their dyspnoea on a scale (42% [26]). A survey of respiratory and palliative care doctors in Australia and New Zealand also found that a minority reported using a breathlessness scale in clinical practice (30 and 18% for respiratory and palliative care respectively) [22].…”