Moran Thomas, Zentner Dominica, Wong James, Philip Jennifer, Smallwood Natasha
The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
BMJ Support Palliat Care. 2023 Dec 7;13(e2):e334-e343. doi: 10.1136/bmjspcare-2020-002853.
Low-dose oral opioids may improve severe chronic breathlessness in advanced cardiorespiratory diseases. Prescription of opioids for breathlessness occurs infrequently however, with little known about patients' attitudes towards their use in this setting. The aim of this qualitative study was to explore patients' perceptions regarding opioids for the management of severe chronic breathlessness in people with advanced cardiorespiratory disease.
A cross-sectional, qualitative study was undertaken using outpatients with severe chronic breathlessness due to either severe chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF). Indepth, semistructured interviews were audio-recorded, transcribed verbatim and coded. Thematic analysis was undertaken to extrapolate recurring ideas from the data.
Twenty-four participants were purposively sampled from three different groups: opioid-naïve patients with COPD (n=7), opioid-naïve patients with CHF (n=7) and patients with COPD using opioids currently or previously for severe chronic breathlessness (n=10). Four major themes were shared by both the and cohorts: (1) stigmatised attitudes and beliefs regarding opioids, (2) limited knowledge and information-seeking behaviour regarding opioids, (3) the impact of the relationships with health professionals and continuity of care, and (4) the significance of past experiences with opioids. An additional theme that was unique to the opioid-experienced cohort was (5) the perception of benefit and improved quality of life.
Lack of knowledge regarding the role of opioids in managing severe chronic breathlessness, opioid misinformation and social stigmas are major barriers to opioid therapy that may be overcome by accurate information from trusted health professionals.
低剂量口服阿片类药物可能改善晚期心肺疾病患者严重的慢性呼吸困难。然而，因呼吸困难开具阿片类药物的处方并不常见，对于患者在这种情况下使用阿片类药物的态度知之甚少。这项定性研究的目的是探讨患者对阿片类药物用于治疗晚期心肺疾病患者严重慢性呼吸困难的看法。
采用横断面定性研究，研究对象为患有严重慢性阻塞性肺疾病（COPD）或慢性心力衰竭（CHF）导致严重慢性呼吸困难的门诊患者。深入的半结构化访谈进行了录音、逐字转录并编码。采用主题分析法从数据中推断出反复出现的观点。
从三个不同组中有意抽取了24名参与者：未使用过阿片类药物的COPD患者（n = 7）、未使用过阿片类药物的CHF患者（n = 7）以及目前或以前因严重慢性呼吸困难使用过阿片类药物的COPD患者（n = 10）。未使用过阿片类药物组和使用过阿片类药物组共同拥有四个主要主题：（1）对阿片类药物的污名化态度和信念，（2）关于阿片类药物的知识有限及信息寻求行为，（3）与医护人员关系及护理连续性的影响，（4）过去使用阿片类药物经历的重要性。使用过阿片类药物组特有的另一个主题是（5）对益处的认知和生活质量的改善。
对阿片类药物在治疗严重慢性呼吸困难中作用的知识缺乏、阿片类药物的错误信息以及社会污名是阿片类药物治疗的主要障碍，值得信赖的医护人员提供准确信息可能会克服这些障碍。
