Identification and Assessment of Breathlessness in Clinical Practice: A Systematic Review and Narrative Synthesis

Abstract

ContextBreathlessness is common in chronic conditions but often goes unidentified by clinicians. It is important to understand how identification and assessment of breathlessness occurs across healthcare settings, to promote routine outcome assessment and access to treatment ObjectiveTo summarise how breathlessness is identified and assessed in adults with chronic conditions across different healthcare settings. MethodsThis is a systematic review and descriptive narrative synthesis (PROSPERO registration: CRD42018089782). Searches were conducted on Medline, PsycINFO, Cochrane Library, Embase and CINAHL (2000-2018) and reference lists. Screening was conducted by two independent reviewers, with access to a third, against inclusion criteria. Data were extracted using a bespoke proforma. ResultsNinety-seven studies were included; conducted in primary care (n=9), secondary care (n=53) and specialist palliative care (n=35). Twenty-five measures of identification and 41 measures of assessment of breathlessness were used. Primary and secondary care used a range of measures to assess breathlessness severity, cause, and impact for people with chronic obstructive pulmonary disease (COPD). Specialist palliative care used measures assessing broader symptom severity and function with less focus on overall quality of life (QoL). Few studies were identified from primary care. ConclusionVarious measures were identified, reflective of the setting's purpose. However, this highlights missed opportunities for breathlessness management across settings; primary care is particularly well-placed to diagnose and support breathlessness. The COPD approach (where symptoms and QoL are part of disease management) could apply to other conditions. Better documentation of holistic patient-reported measures may drive service improvement in specialist palliative care.

Management of Dyspnea in Advanced Cancer: ASCO Guideline

“…The review conducted for the first three clinical questions (assessment of dyspnea, management of reversible causes of dyspnea, and referral to palliative care and/or specialty breathlessness services) included six publications: four systematic reviews [15][16][17][18] and two guidelines. 1,19 The AHRQ systematic review on the treatment of dyspnea (questions 4-5) included 48 RCTs and two retrospective cohort studies.…”

Dyspnoea-12 and Multidimensional Dyspnea Profile: Systematic Review of Use and Properties

“…While these two instruments have been available for at least a decade, the extent to which these instruments are being used is unclear. Of the comprehensive reviews (systematic or narrative) of breathlessness instruments published since 2010, a number do not include the D-12 or MDP [8][9][10][11], or where these instruments have been included, limited detail is provided on their psychometric properties [3,[12][13][14][15]. The focus of this systematic review and meta-analysis was to specifically evaluate D-12 and MDP in terms of their use, reported scores and psychometric properties across populations, settings, and languages.…”

Health service utilisation associated with chronic breathlessness: random population sample

“…However, in one study three-quarters of ED attendees due to breathlessness stated they had talked to their general practitioner about their breathlessness [ 18 ]; other studies present suboptimal engagement of primary care in chronic breathlessness management, with many patients reporting disappointment with their consultation [ 49 , 50 ] or lack of timely primary care support as a reason to seek emergency hospital care [ 15 ]. Lack of identification and assessment of [ 51 ], and interventions for, breathlessness in primary care given that patients do present with this symptom [ 17 ], represents lost opportunities for evidence-based management, especially for supported self-management strategies with non-pharmacological interventions, which have proven efficacy [ 52 ].…”