Division of Respirology at the Queen Elizabeth II Health Sciences Centre in Halifax, NS, Canada.
Can Fam Physician. 2012 Jul;58(7):e401-7.
To explore the experiences of family physicians and respiratory therapists in treating advanced chronic obstructive pulmonary disease (COPD) and their attitudes to the use of opioids for dyspnea in this context.
Qualitative methodology using one-on-one semistructured interviews.
Southern New Brunswick (St Stephen to Sussex).
Ten family physicians and 8 respiratory therapists who worked in primary care settings.
Participant interviews were audiorecorded, transcribed verbatim, coded conceptually, and thematically analyzed using interpretive description.
Participants reported that patients with advanced COPD often suffered from inadequate control of their dyspnea in advanced stages and that they saw the potential value of opioids in this context; however, family physicians described discomfort prescribing opioids. Barriers included insufficient knowledge, lack of education and guidelines, and fear of censure. Those with palliative care experience tended to be more comfortable with opioid prescribing.
Findings suggest an important need to address barriers related to more effective treatment of refractory dyspnea in advanced COPD. Further, findings indicate these efforts should focus on effective palliation and innovative educational initiatives, as well as the development, promotion, and uptake of evidence-based practice guidelines related to prescribing opioids for these patients.
探索家庭医生和呼吸治疗师在治疗晚期慢性阻塞性肺疾病（COPD）方面的经验，以及他们在这种情况下对使用阿片类药物治疗呼吸困难的态度。
采用一对一半结构化访谈的定性方法。
新不伦瑞克省南部（圣斯蒂芬到苏塞克斯）。
10 名在初级保健环境中工作的家庭医生和 8 名呼吸治疗师。
对参与者的访谈进行录音、逐字转录、概念编码，并使用解释性描述进行主题分析。
参与者报告说，晚期 COPD 患者在晚期经常遭受呼吸困难控制不足的困扰，他们认为阿片类药物在这种情况下有潜在价值；然而，家庭医生描述了开阿片类药物的不适。障碍包括知识不足、缺乏教育和指南以及对指责的恐惧。有姑息治疗经验的人往往更愿意开阿片类药物。
研究结果表明，需要解决与晚期 COPD 难治性呼吸困难更有效治疗相关的障碍。此外，研究结果表明，这些努力应侧重于有效姑息治疗和创新教育举措，以及制定、推广和采用与为这些患者开阿片类药物相关的基于证据的实践指南。
