纤维化间质性肺病和慢性阻塞性肺病患者在缓解治疗中使用阿片类药物治疗呼吸困难的看法:定性研究。

Camilla Yde Hvelplund, Birgit Refsgaard, Elisabeth Bendstrup
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引用次数: 0

摘要

背景:许多慢性阻塞性肺病和纤维化间质性肺病患者尽管接受了最佳的疾病调节治疗,但仍有严重的呼吸困难和生活质量下降。研究表明,这些患者可能会从低剂量阿片类药物治疗中获益。然而,许多患者拒绝接受阿片类药物治疗。目的:找出妨碍患者接受适当阿片类药物姑息治疗的潜在障碍,使医生能够解决患者的顾虑:设计:基于半结构化访谈的定性研究。采用 NVivo 对访谈进行誊写和主题分析:患者在罕见肺病中心或奥胡斯大学医院慢性阻塞性肺病门诊进行门诊随访时被招募。符合条件的患者年满 18 周岁,目前未服用阿片类药物或曾因呼吸困难服用过阿片类药物:共有 28 名患者参与。在对 27 名患者进行最终分析之前,排除了一名患者。确定了四个主题:害怕副作用、需要更多信息、阿片类药物与重病和死亡相关的耻辱感以及无明显障碍。此外,还确定了 "害怕副作用 "的三个次主题:担心上瘾、担心镇静作用、担心因无法驾驶汽车而丧失行动能力。表达最多的担忧是害怕副作用,尤其是上瘾:结论:对阿片类药物的先入为主的观念阻碍了一些慢性阻塞性肺病或间质性肺病患者因呼吸困难而接受姑息治疗。
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Perceptions on Use of Opioids in Palliative Care of Dyspnoea in Patients with Fibrotic interstitial lung disease and Chronic Obstructive Pulmonary Disease: A Qualitative Study.

Background: Many patients with chronic obstructive pulmonary disease and fibrotic interstitial lung disease suffer from severe dyspnea and reduced quality of life, despite receiving optimal disease-modifying treatment for their illness. Studies have suggested that these patients may benefit from treatment with low-dose opioids. However, many patients decline opioid treatment. This has led to patients not receiving proper palliative treatment of their lung disease.

Aim: To identify potential barriers that prevent patients from receiving adequate palliative care with opioids and enable doctors to address patients' concerns.

Design: A qualitative study based on semi-structured interviews. Interviews were transcribed and thematic analysis was done using NVivo.

Setting/participants: Patients were recruited when scheduled for out-patient follow-up at Center for Rare Lung Diseases or at the COPD clinic, Aarhus University Hospital. Eligible patients were 18 years of age, did not currently receive opioids or had ever received opioids for dyspnea.

Results: A total of 28 patients participated. One patient was excluded before final analysis of 27 patients. Four themes were identified: Fear of side-effects, Need for more information, Stigma of opioids association with severe illness and dying, and No discernible barriers. Furthermore, three sub-themes to Fear of side-effects were identified: Fear of addiction, concern for sedative effect, and fear for loss of mobility due to inability to drive a car. The most expressed concern was Fear of side-effects, especially addiction.

Conclusions: Pre-conceived notions about opioids prevent some patients with chronic obstructive lung disease or interstitial lung disease from receiving palliative care for breathlessness.

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