Patients Who Are Near Death Are Frequently Unable To Self-Report Dyspnea

Campbell, Margaret L.; Templin, Thomas; Walch, Julia

doi:10.1089/jpm.2009.0082

Cited by 39 publications

(20 citation statements)

References 23 publications

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“…20 It was initially validated with a group of patients undergoing pulmonary rehabilitation, and compared with healthy volunteers and patients with postoperative pain. 21 Several items in the RDOS, such as extent of accessory muscle use and look of fear, are dependent on the assessors' experience and judgment.…”

Section: Fig 1 Study Flow Diagrammentioning

confidence: 99%

Dyspnea in Hospitalized Advanced Cancer Patients: Subjective and Physiologic Correlates

Hui

Morgado

Vidal³

et al. 2013

Journal of Palliative Medicine

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Background and objective: It is unclear if physiologic measures are useful for assessing dyspnea. We examined the association among the subjective rating of dyspnea according to patients with advanced cancer, caregivers and nurses, and various physiologic measures. Methods: We conducted a cross-sectional survey of patients with cancer hospitalized at MD Anderson Cancer Center. We asked patients, caregivers, and nurses to assess the patients' dyspnea at the time of study enrollment independently using a numeric rating scale (0 = none, 10 = worst). Edmonton Symptom Assessment Scale (ESAS) ratings, causes of dyspnea, vitals, and Respiratory Distress Observation Scale [RDOS] ratings were collected. Results: A total of 299 patients were enrolled in the study: average age 62 (range 20-98), female 47%, lung cancer 37%, and oxygen use 57%. The median RDOS rating was 2/16 (interquartile range 1-3) and the number of potential causes was 3 (range 2-4), with pleural effusion (n = 166, 56%), pneumonia (n = 144, 48%), and lung metastasis (n = 125, 42%) being the most common. The median intensity of patients' dyspnea at the time of assessment was 3 (interquartile range 0-6) for patients, 4 (interquartile range 1-6) for caregivers, and 2 (interquartile range 0-3) for bedside nurses. Patients' expression of dyspnea correlated moderately with caregivers' (r = 0.68, p < 0.001) and nurses' (r = 0.50, p < 0.001) assessments, and weakly with RDOS (r = 0.35, p < 0.001), oxygen level (r = 0.32, p < 0.001), and the number of potential causes (r = 0.19, p = 0.001). In multivariate analysis, patients' dyspnea was only independently associated with ESAS dyspnea ( p = 0.002) and dyspnea as assessed by caregivers ( p < 0.001). Conclusion: Patients' level of dyspnea was weakly associated with physiologic measures. Caregivers' perception may be a useful surrogate for dyspnea assessment.

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Section: Fig 1 Study Flow Diagrammentioning

confidence: 99%

Dyspnea in Hospitalized Advanced Cancer Patients: Subjective and Physiologic Correlates

Hui

Morgado

Vidal³

et al. 2013

Journal of Palliative Medicine

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“…The inability of an individual to self-report dyspnea may result in a failure by nurses to identify this as a change in the patient status from a physiological perspective and appropriately treat this distressing symptom [44] . Campbell [43] suggests that stimulation of the autonomic nervous system produces observational and measurable behaviors.…”

Section: Dyspneamentioning

confidence: 99%

Best practice in nursing care of dyspnea: The 6th vital sign in individuals with COPD

Bailey

Boyles

Cloutier

et al. 2013

JNEP

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Aim: The aim of this paper is to highlight evidence and key nursing practice, education, organization and policy recommendations from the original and revised Registered Nurses' Association of Ontario Best Practice Guideline, Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD). This paper introduces the notion of dyspnea as the sixth vital sign and presents evidence from the RNAO Best Practice Guideline and other relevant literature to support and enhance nursing care of dyspnea in clients with COPD.Background: COPD is an increasingly serious health issue. Nurses have significant opportunity to positively influence client outcomes and quality of life by assessing dyspnea, identifying problems, and applying appropriate evidence-based interventions. Best practice guidelines developed by the RNAO provide a framework to enhance nursing practice and client care.Design: A panel of nurses was assembled for the initial development of the guideline and more recently, the revision to the original guideline.Method: A structured evidence review based on the scope of the original guideline and supported by three clinical questions was conducted to capture the relevant literature and guidelines published since the original publication.Results: As a result of this work recommendations for nursing practice and education are discussed. Organizational and policy recommendations are also outlined. Conclusions:Nurses have opportunity to positively influence client outcomes and quality of life by assessing dyspnea, identifying problems, and applying appropriate evidence-based interventions.Relevance to Clinical Practice: Recommendations made in the best practice guideline will enhance nursing care of dyspnea in clients with COPD and dyspnea should be recognized as the sixth vital sign in individuals with COPD.

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“…By the means of consciousness and cognition, a symptom or affliction may be reported, focusing in the informs and sensorial stimulus (21). In the observational study of Campbell and colleagues (21), with 89 patients receiving palliative care and with imminence in the appearance of dyspnea due to the advance of the basal disease, the symptom was asked using the VAS; 54% of the patients were incapable of answering yes or no due to the consciousness level and, of the 41 respondents, only 20 were able to quantify using the scale, which demonstrate that the selfreport is associated to consciousness, cognition, and severity of the terminal illness, which requires great attention while dealing with palliative care, where symptoms may be ignored, under or over-treated.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, those with cognitive impairment assessed by the Mini-Mental State Examination (MMSE) (20) were also excluded, since this function is necessary to report a symptom or affliction (21).…”

Section: Studied Individualsmentioning

confidence: 99%

Reported dyspnea and fatigue using different scales during the physical effort in COPD

et al. 2017

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Introduction: Therapy choice and its progression for patients with Chronic Obstructive Pulmonary Disease (COPD) should be based on their symptoms and clinical condition according to reports of dyspnea and fatigue. Therefore patient-reported scales have presented a key role during the communication with the patient. Objective: To verify if patients with COPD prefer the Modified Borg Scale (MBS), Visual Analogue Scale (VAS), Glasses Scale (GS), Faces Scale (FS) or Ratings of Perceived Exertion (RPE) during the six-minute walk test(6MWT), and to compare and correlate the scales with each other, with peripheral oxygen saturation (SpO2) and heart rate (HR). Methods: 28 patients with COPD (50% had mild to moderate COPD and 50% had severe to very severe) were evaluated by a respiratory and cognitive assessment. Additionally, they performed the 6MWT, in which the scales were applied simultaneously (random order) and patients reported their preference in the end of the test. Results: 57% of patients were illiterate or presented incomplete primary education and most of them (67%) chose the FS or GS. Significant positive correlations were observed between instruments for both dyspnea and fatigue in the end of the 6MWT, which the strongest was between MBS and

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Patients Who Are Near Death Are Frequently Unable To Self-Report Dyspnea

Cited by 39 publications

References 23 publications

Dyspnea in Hospitalized Advanced Cancer Patients: Subjective and Physiologic Correlates

Dyspnea in Hospitalized Advanced Cancer Patients: Subjective and Physiologic Correlates

Best practice in nursing care of dyspnea: The 6th vital sign in individuals with COPD

Reported dyspnea and fatigue using different scales during the physical effort in COPD

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