Long-term oxygen therapy: review from the patients’ perspective

Abstract

Chronic respiratory conditions are responsible for increasing numbers of patients in need of long-term oxygen therapy (LTOT). However, many patients do not use their oxygen as prescribed. Unless we can assist these patients in living with oxygen therapy, optimal clinical outcomes will not be achieved. We conducted a meta-synthesis of qualitative research studies. We included any qualitative study that focused on the psychosocial nature or experience of patients prescribed LTOT. Four research studies met the conditions of our search. We performed a rigorous methodological protocol for meta-synthesis as described by the Joanna Briggs Institute. A total of 12 findings formulated four themes. These themes included the following: adapting oxygen to life's circumstances, living in a restricted world, self-management is fostered by oxygen, and submission and dependency. From the four thematic categories established, meta-synthesis resulted in two major results: persons prescribed oxygen rationalize its use while negotiating lifestyle interference and physical restrictions and the drive to care for one's self is conflicted. This meta-synthesis showed that each oxygen user faces tremendous physical, psychological, and emotional challenges. They strive to adapt and maintain mastery but eventually oxygen dependency results. These challenges affect the patient's ability to adhere to their treatment guidelines. These barriers and challenges are seldom addressed and are under-treated. Clinicians involved in LTOT need to be aware and work with the patients to facilitate their use of oxygen. Inclusion of the patients' perspective can guide practice and assist with the development of new interventions and management strategies.

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

“…2 l Breathlessness resulted in reduced activity (sometimes exacerbated by the lack of portability of treatment such as LTOT) leading to 'misery and isolation, especially alongside stigma and guilt' (p. 144). 144 The nature of the progression of COPD often led to a 'fear of dying' (p. 298), 143 and was related to a vicious cycle of anxiety and dyspnoea. Alternative forms of activity and social support might improve the experience of living with COPD.…”

“…55 137 patients' experience of depression management in primary care, support groups, self-help clinics 135 and patients' experience of antidepressant medication 136 COPD 3 Two reviews were qualitative syntheses; one on COPD patients' experiences of breathlessness 143 and the other on experiences of LTOT. 144 The remaining review was a mixed-methods synthesis examining telemedicine services for patients with COPD 145 …”

“…The COPD qualitative meta-review included three reviews [143][144][145] Two reviews were qualitative syntheses: one on COPD patients' experiences of breathlessness 143 and the other on experiences of long-term oxygen therapy (LTOT) 144 ( Table 47). The remaining review was a mixed-methods synthesis examining telemedicine services for patients with COPD.…”

Caregivers' Perspectives on the Use of Long-Term Oxygen Therapy for the Treatment of Refractory Breathlessness: A Qualitative Study

“…It has the potential to alter the meaning of home [18,19] and for some caregivers, may serve as a constant reminder of a person's underlying chronic illness, physical limitations and approaching death [19]. Our findings also highlight the widely held view that oxygen is life sustaining; perhaps revealing a gap in understanding of the refractory nature of breathlessness and poor prognosis.…”

“…Consistent with findings from a Brazilian study exploring the quality of life and burden in carers for people with COPD [13], our findings also show that just as oxygen can 'bind' patients it can also 'bind' caregivers contributing to possible caregiver fatigue and potentially other burdens including those of a social and financial nature. Just as people who have been prescribed oxygen often have to balance their now restricted life world and increasing dependency, with the advantages that oxygen provided [18] so do caregivers.…”