title: Perspectives of patients, family caregivers and physicians about the use of opioids for refractory dyspnea in advanced chronic obstructive pulmonary disease.
abstract: BACKGROUND
  A recent national practice guideline recommends the use of opioids for the treatment of refractory dyspnea in patients with advanced chronic obstructive pulmonary disease (COPD). We conducted two qualitative studies to explore the experiences of patients and family caregivers with opioids for refractory COPD-related dyspnea and the perspectives and attitudes of physicians toward opioids in this context.
  
  
  METHODS
  Patients (n = 8; 5 men, 3 women), their caregivers (n = 12; 5 men, 7 women) and physicians (n = 28, 17 men, 11 women) in Nova Scotia participated in the studies. Semistructured interviews were recorded, transcribed verbatim, coded conceptually and analyzed for emergent themes using interpretive description methodology.
  
  
  RESULTS
  Patients reported that opioids provided a sense of calm and relief from severe dyspnea. Family caregivers felt that opioids helped patients to breathe more "normally," observed improvements in patients' symptoms of anxiety and depression, and experienced reductions in their own stress. Patients reported substantial improvements in their quality of life. All patients and family caregivers wanted opioid therapy to continue. Most physicians were reluctant to prescribe opioids for refractory dyspnea, describing a lack of related knowledge and experience, and fears related to the potential adverse effects and legal censure.
  
  
  CONCLUSIONS
  Discrepancies between the positive experiences of patients and family caregivers with opioids and the reluctance of physicians to prescribe opioids for refractory dyspnea constitute an important gap in care. Bridging this gap will require initiatives to improve the uptake of practice guidelines and to increase confidence in prescribing opioids for dyspnea refractory to conventional treatment.
authors.affiliation: Division of Respirology, Queen Elizabeth II Health Science Centre and Dalhousie University, Halifax, NS. graeme.rocker@dal.ca
authors.forename: Graeme
authors.initials: G
authors.lastname: Rocker
authors.forename: Joanne
authors.initials: J
authors.lastname: Young
authors.forename: Margaret
authors.initials: M
authors.lastname: Donahue
authors.forename: Morag
authors.initials: M
authors.lastname: Farquhar
authors.forename: Catherine
authors.initials: C
authors.lastname: Simpson
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000592:standards*; D004334:Drug Administration Schedule; D004417:Dyspnea / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009674:Nova Scotia; D010353:Patient Education as Topic; D010820:Physicians / Q000592:standards*; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis; D012720:Severity of Illness Index
chemical_list: D000701:Analgesics, Opioid