Correlates and Predictors of Changes in Dyspnea Symptoms Over Time Among Community-Dwelling Palliative Home Care Clients

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• 作者：Shannon Freeman ; PhD^a ; ^{shannon.freeman@unbc.ca" class="auth_mail" title="E-mail the corresponding author} ; John P. Hirdes ; PhD^b ; ^c ; Paul Stolee ; PhD^b ; John Garcia ; PhD^b ; Trevor Frise Smith ; PhD^c ; ^d
• 关键词：interRAI palliative care assessment instrument ; end of life ; community-based care ; shortness of breath ; clinical assessment protocol
• 刊名：Journal of Pain and Symptom Management
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：50
• 期：6
• 页码：793-805
• 全文大小：165 K

文摘

Dyspnea is a frequently reported and highly distressing symptom for persons nearing end of life, affecting the quality of living and dying.

Objectives

This study described health and clinical characteristics of persons experiencing dyspnea who receive palliative home care services and identified factors affecting change in dyspnea over time.

Methods

Anonymized assessments (N = 6655 baseline; 959 follow-up) from the interRAI palliative care assessment instrument (interRAI PC) were collected during pilot implementation (2006–2011). Triggering of the interRAI PC dyspnea clinical assessment protocol was used to indicate presence of dyspnea. Bivariate and logistic regression analyses described risk and protective factors for developing new dyspnea and for recovery from dyspnea at follow-up.

Results

At baseline, 44.9% of persons exhibited dyspnea. Dyspnea was more prevalent among older adults, males, persons with shortened prognoses, and persons without cancer. Persons with dyspnea were more likely to experience functional impairment, moderate cognitive impairment, fatigue, weight loss, and urinary incontinence. Among persons with dyspnea at baseline, 31.5% recovered from dyspnea at follow-up. In contrast, 31% of persons without dyspnea at baseline reported new dyspnea at follow-up. Risk factors for developing new dyspnea included smoking, fatigue, and receiving oxygen therapy.

Conclusion

Results highlight that dyspnea is not inevitable as persons progress toward death. Accordingly, dyspnea should be identified and prioritized during the care planning process. Integrated approaches using the interRAI PC dyspnea clinical assessment protocol may assist clinicians to make informed decisions addressing dyspnea at the person-level and thereby improve quality of life at the end of life.