The Evidence Base for Oxygen for Chronic Refractory Breathlessness: Issues, Gaps, and a Future Work Plan

Abstract

Please note that any alterations made during the publishing process may not appear in this version."NOTICE: this is the authors' version of a work that was accepted for publication in the Journal of Pain and Symptom Management. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Cities. Published Journal Articles (PJAs) Definition: A published journal article (PJA) is the definitive final record of published research that appears or will appear in the journal and embodies all value-adding publisher activities including copy-editing, formatting and (if relevant) pagination. Policy: Elsevier guarantees each PJA's authenticity, we work with others (e.g. national libraries) to preserve them for posterity and in perpetuity, and we invest to drive their usage. We strictly apply an absolute guideline regarding their location: every PJA will reside only on a completely controlled site because this is the only way that we as the publisher can guarantee each PJA's permanence, authenticity and that it is not altered. The continued viability of scholarly journals and their PJAs is also important to the research community. Publishers invest significant time, money and resources to create, maintain and develop both journals' reputations and the publishing process. The distribution of PJAs is therefore also subject to strict guidelines so that journals' ability to recoup the investments required to create them are not compromised. An author may use the PJA for personal use and internal institutional use (see above for definitions of these terms). In the interest of safeguarding the correct scientific record, however, Elsevier does not permit the posting of PJAs (Elsevier-provided PDF or HTML files) on any open websites. This is to ensure that the final published version of an article, which has been edited and peer-reviewed according to the publishing standards of an Elsevier journal, is always recognized as such only via the journal itself, whether in print or electronic format. PJAs may not be used for commercial use or for systematic distribution (see above for definitions of these terms). AbstractBreathlessness or "shortness of breath", medically termed dyspnoea, remains a devastating problem for many people and those who care for them. As a treatment intervention, administration of opioids to relieve breathlessness is an area where progress has been made with the development of an evidence base. As evidence in support of opioids has accumulated, so has our collective understanding about trial methodology, research collaboration and infrastructure that is crucial to generate reliable research results for palliative care clinical settings.Analysis of achievements to date and what it takes to accomplish these studies provides important insights into knowledge g...

A wolf in sheep's clothing? Patients’ and healthcare professionals’ perceptions of oxygen therapy: An interpretative phenomenological analysis

“…Similarly, the majority of HCPs regarded oxygen as a universal remedy, a belief which stems from experience that it works ! Overuse and misunderstanding of oxygen by HCPs is common, although rationale appears elusive. It has been intimated previously that a culture may exist whereby oxygen is given automatically to patients who present as critically ill or dyspnoeic; this is the first time that this culture, underpinned by beliefs, misconceptions and myths, has been captured and reported as empirical data.…”

“…Whilst there is no doubt that it's use to correct hypoxaemia is essential, there is a growing body of evidence suggesting that when too much oxygen is given, this may lead to adverse events and even death . Additionally, the use of oxygen to relieve dyspnoea is increasingly controversial, seemingly exacerbated by a lack of clear guidance and consensus . The publication of the first UK (United Kingdom) Emergency Oxygen Guidelines challenged established custom but, despite this initiative, audit suggests persistence of poor practices .…”

Difficult decisions: An interpretative phenomenological analysis study of healthcare professionals’ perceptions of oxygen therapy in palliative care

“…[3,40] It has been suggested that excellent communication is required to discuss difficult decisions [41]addressing a patient's fears of dyspnoea needs to be a key priority for HCPs, in addition to education regarding futility and dangers of oxygen.…”

Evidence for Oxygen Use in the Hospitalized Patient: Is More Really the Enemy of Good?

“…125 Of the 13 studies reviewed, 2 showed a benefit when supplementing oxygen to breathless subjects. These 2 studies involved COPD patients, and the benefit of oxygen administration was small and limited to breathlessness as a result of exertional desaturation in one study.…”