Patients’ and caregivers’ experiences of driving with chronic breathlessness before and after regular low-dose sustained-release morphine: A qualitative study

Boland, Jason W; Kochovska, Slavica; Honson, Aaron; Phillips, Jane; Currow, David C.

doi:10.1177/0269216320929549

Cited by 4 publications

(8 citation statements)

References 55 publications

(64 reference statements)

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“…In fear of the occurrence of respiratory depression or other adverse effects, physicians indicate to be hesitant to prescribe opioids to patients with advanced COPD. [92][93][94] Systematic reviews on the effects of opioids on chronic breathlessness showed no evidence for an effect of opioids on respiratory outcomes. [82][83][84] On the contrary, three case reports have described cases of serious respiratory depression after high doses of nebulized morphine, 95 immediate-release oral morphine 96 or transmucosal fentanyl.…”

Section: Safety and Adverse Effectsmentioning

confidence: 99%

“…91 For patients with COPD, driving is also essential to attend therapy or go to a doctor's appointment. 92,93 Due to possible adverse effects as dizziness, patients are advised against driving during therapy initiation or upward dose titration. Where high doses can impair driving, 94 patients receiving stable lowdose morphine and their caregivers don't experience impairment of driving skills of the patient.…”

Section: Willingness Of Patientsmentioning

confidence: 99%

“…Main reasons for not treating with opioids mentioned by physicians are insufficient knowledge or experience, risk of adverse effects, including respiratory depression, resistance of the patient and lack of guidelines. [92][93][94][109][110][111] Small qualitative studies in patients revealed barriers like fear of dependence and fear of imminent death. 93,112 Clinical studies on the effect of opioids had difficulties including patients.…”

mentioning

confidence: 99%

“…[92][93][94][109][110][111] Small qualitative studies in patients revealed barriers like fear of dependence and fear of imminent death. 93,112 Clinical studies on the effect of opioids had difficulties including patients. 98,113 Patients that did start opioid treatment mentioned doing as much as possible as most important reason.…”

mentioning

confidence: 99%

“…98,113 Patients that did start opioid treatment mentioned doing as much as possible as most important reason. 93,112…”

mentioning

confidence: 99%

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Chronic breathlessness in COPD

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Chronic obstructive pulmonary disease (COPD)COPD is defined as 'a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases and influenced by host factors including abnormal lung development. Significant comorbidities may have an impact on morbidity and mortality'. 1 Worldwide, the prevalence of COPD was estimated by the Global Burden of Disease Study at 3.9% in 2017. 2 COPD is a major cause of burden and mortality. Annually, COPD accounts for 5.7% of all-cause deaths and 3.3% of all-cause disability-adjusted life years. 2 In the Netherlands, the prevalence was estimated at 3.4% in 2019, and about 7000 people died because of COPD. 3 Due to longevity and persistent exposure to COPD risk factors, prevalence and burden of COPD will continue to increase. 1 According to the World Health Organization (WHO), COPD will be the fourth leading cause of mortality and the seventh leading cause of disability-adjusted life years in 2030. 4 COPD is also associated with an increased economic and societal burden. COPD results in increased disability, leading to increased healthcare costs. Within the European Union, 6% of healthcare spending is accounted to direct costs of COPD. 5 Especially exacerbations and hospital admissions attribute to an increase in healthcare costs. [6][7][8][9] Most common symptoms in advanced COPD are breathlessness, fatigue, muscle weakness, cough and sputum production. 1,10 Presence of these symptoms has a major impact on quality of life and functional status. 11-13 A prospective survey among 100 patients with advanced COPD showed that impairment in quality of life was strongly associated with high symptom burden, disease-related dysfunction and impaired psychological wellbeing. 14 Furthermore, COPD is associated with a higher number of comorbidities than other diseases, 15 including cardiovascular, cachectic, metabolic and psychological comorbidities. 10,16 As was shown by a cross-sectional analysis of Scottish national data, half of patients with COPD aged over 65 has at least three other morbidities. 17 Management of COPD includes reduction of exposure to risk factors like smoking cessation, pharmacological treatment like inhaled bronchodilators or corticosteroids and nonpharmacological treatment like pulmonary rehabilitation. In patients who still experience symptoms despite optimal pharmacological and nonpharmacological management, palliative care is indicated. 1 12 Chapter 1 work/effort and air hunger, patients usually experience all clusters during an exacerbation. 34,35,[38][39][40] Assessing breathlessness Measurement of breathlessness serves different purposes. First, measures can be used to discriminate between patients with mild or severe breathlessness. Second, change of breathlessness over time can be measured, for instance to evaluate the effectiveness of an intervention. 41 Since breathlessness ...

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Section: Safety and Adverse Effectsmentioning

confidence: 99%

Section: Willingness Of Patientsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

“…98,113 Patients that did start opioid treatment mentioned doing as much as possible as most important reason. 93,112…”

mentioning

confidence: 99%

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Chronic breathlessness in COPD

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Driving communication forward: improving communication for palliative care patients around driving and opioids – a quality improvement report

et al. 2023

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IntroductionThe number of people requiring palliative care is increasing with an ageing comorbid population. Pain is a prevalent symptom for palliative care patients and is often managed with opioids. Opioids reduce reaction time and can cause drowsiness and visual disturbance. Evidence recommends that driving should be avoided until a stable dose of opioids has been reached. It is vital for patient and public safety that these facts are communicated to patients who are prescribed opioids, as well as the legal consequences if guidance is not followed. These discussions facilitate joint decisions, optimising patient freedom and quality of life. Surprisingly though these important discussions around driving and opioids do not always occur, and so this project sought to develop a systematic approach to integrating them into practice.DesignRetrospective case note analysis and prospective interventional quality improvement study.SettingA 16 bedded specialist palliative care inpatient unit.PopulationHospice inpatients with an Eastern Council Oncology Group performance score of 0–3 who had been prescribed opioids.InterventionThree plan–do–study–act cycles were performed. First, the issue was discussed in the daily multidisciplinary team meeting to raise awareness, second a prompt was added to a pre-existing clerking proforma. Finally, a reminder poster was placed in the ward office to promote discussion prior to discharge.Outcome measuresPrimary measures were the proportion of patients with the presence of documented driving status, and the presence of a documented discussion surrounding driving and opioids.ResultsBaseline data found that 11.5% of patients had a documented driving status and 11.5% had a documented discussion surrounding driving and opioids. Over the course of the study, the proportion improved to 65.2% and 60.9%, respectively.ConclusionUse of quality improvement change methods have resulted in the successful integration of new interventions to increase discussions around driving when prescribed opioids. A previously overlooked issue in this facility, thus improving clinical and patient information sharing, and patient empowerment to take charge of their own health.

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Opioids and driving: education gaps in advanced cancer

Anil

Smallwood

Dunn

2021

BMJ Support Palliat Care

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ObjectivesOpioids may impair the ability to drive safely, particularly when first prescribed or with dose titration. We investigated whether clinicians evaluate driving status and provide opioid-related driving advice when initiating opioids among people with advanced lung cancer.MethodsA retrospective medical record review of outpatients with advanced non-small cell lung cancer seen at an Australian tertiary referral centre between 1 January 2015 and 31 December 2019 was undertaken to determine frequency of opioid prescription and documentation of driving status and education regarding driving safety while taking opioids.ResultsOf 1022 patients screened, 205 were commenced on opioid therapy. Forty-seven (23%) patients had driving status documented. According to medical records, education about driving safety while on opioids was provided to two (1%) patients on opioid initiation. Ten (5%) patients received opioid-related driving education at least once at follow-up appointments. The content of the education was infrequently documented, and when documented, focused on opioid side effects impacting driving. Opioid doses were often escalated at follow-up appointments.ConclusionsAccording to documentation in medical records, clinicians infrequently assessed driving status on opioid initiation and rarely provided education regarding opioid-related driving risks. Further research and clearer guidance regarding opioids and driving safety in the cancer population are required.

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Patients’ and caregivers’ experiences of driving with chronic breathlessness before and after regular low-dose sustained-release morphine: A qualitative study

Cited by 4 publications

References 55 publications

Chronic breathlessness in COPD

Chronic breathlessness in COPD

Driving communication forward: improving communication for palliative care patients around driving and opioids – a quality improvement report

Opioids and driving: education gaps in advanced cancer

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