1 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK.
2 School of Health Sciences, University of East Anglia, Norwich, UK.
Palliat Med. 2019 Apr;33(4):462-466. doi: 10.1177/0269216319830299. Epub 2019 Feb 15.
Holistic breathlessness services have been developed for people with advanced disease and chronic breathlessness, leading to improved psychological aspects of breathlessness and health. The extent to which patient characteristics influence outcomes is unclear.
To identify patient characteristics predicting outcomes of mastery and distress due to breathlessness following holistic breathlessness services.
Secondary analysis of pooled individual patient data from three clinical trials. Our primary analysis assessed predictors of clinically important improvements in Chronic Respiratory Questionnaire mastery scores (+0.5 point), and our secondary analysis predictors of improvements in Numerical Rating Scale distress due to breathlessness (-1 point). Variables significantly related to improvement in univariate models were considered in separate backwards stepwise logistic regression models.
The dataset comprised 259 participants (118 female; mean (standard deviation) age 69.2 (10.6) years) with primary diagnoses of chronic obstructive pulmonary disease (49.8%), cancer (34.7%) and interstitial lung disease (10.4%).
Controlling for age, sex and trial, baseline mastery remained the only significant independent predictor of improvement in mastery (odds ratio 0.57, 95% confidence intervals 0.43-0.74; p < 0.001), and baseline distress remained the only significant predictor of improvement in distress (odds ratio 1.64; 95% confidence intervals 1.35-2.03; p < 0.001). Baseline lung function, breathlessness severity, health status, mild anxiety and depression, and diagnosis did not predict outcomes.
Outcomes of mastery and distress following holistic breathlessness services are influenced by baseline scores for these variables, and not by diagnosis, lung function or health status. Stratifying patients by levels of mastery and/or distress due to breathlessness appears appropriate for clinical trials and services.
综合呼吸困难服务针对晚期疾病和慢性呼吸困难患者，改善呼吸困难的心理方面和健康状况。但患者特征对结果的影响程度尚不清楚。
确定综合呼吸困难服务后，导致呼吸困难的掌控感和苦恼的预测结果的患者特征。
三项临床试验的个体患者数据的二次分析。我们的主要分析评估了慢性呼吸系统问卷掌控感评分（提高 0.5 分）有临床意义的改善的预测因素，我们的次要分析评估了数字评定量表呼吸困难苦恼（降低 1 分）改善的预测因素。在单变量模型中与改善显著相关的变量被纳入单独的向后逐步逻辑回归模型。
数据集包括 259 名参与者（118 名女性；平均（标准差）年龄 69.2（10.6）岁），主要诊断为慢性阻塞性肺疾病（49.8%）、癌症（34.7%）和间质性肺疾病（10.4%）。
在控制年龄、性别和试验后，基线掌控感仍然是提高掌控感的唯一显著独立预测因素（比值比 0.57，95%置信区间 0.43-0.74；p<0.001），基线苦恼仍然是提高苦恼的唯一显著预测因素（比值比 1.64；95%置信区间 1.35-2.03；p<0.001）。基线肺功能、呼吸困难严重程度、健康状况、轻度焦虑和抑郁以及诊断均不能预测结果。
综合呼吸困难服务后掌控感和苦恼的结果受到这些变量基线得分的影响，而不受诊断、肺功能或健康状况的影响。根据呼吸困难的掌控感和/或苦恼程度对患者进行分层似乎适合临床试验和服务。
