Using opioids to treat dyspnea in advanced COPD: attitudes and experiences of family physicians and respiratory therapists.
OBJECTIVE
To explore the experiences of family physicians and respiratory therapists in treating advanced chronic obstructive pulmonary disease (COPD) and their attitudes to the use of opioids for dyspnea in this context.


METHODS
Qualitative methodology using one-on-one semistructured interviews.


METHODS
Southern New Brunswick (St Stephen to Sussex).


METHODS
Ten family physicians and 8 respiratory therapists who worked in primary care settings.


METHODS
Participant interviews were audiorecorded, transcribed verbatim, coded conceptually, and thematically analyzed using interpretive description.


RESULTS
Participants reported that patients with advanced COPD often suffered from inadequate control of their dyspnea in advanced stages and that they saw the potential value of opioids in this context; however, family physicians described discomfort prescribing opioids. Barriers included insufficient knowledge, lack of education and guidelines, and fear of censure. Those with palliative care experience tended to be more comfortable with opioid prescribing.


CONCLUSIONS
Findings suggest an important need to address barriers related to more effective treatment of refractory dyspnea in advanced COPD. Further, findings indicate these efforts should focus on effective palliation and innovative educational initiatives, as well as the development, promotion, and uptake of evidence-based practice guidelines related to prescribing opioids for these patients.
Division of Respirology at the Queen Elizabeth II Health Sciences Centre in Halifax, NS, Canada. graeme.rocker@dal.ca
Joanne
J
Young
Margaret
M
Donahue
Morag
M
Farquhar
Cathy
C
Simpson
Graeme
G
Rocker
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002492:Central Nervous System Depressants / Q000627:therapeutic use*; D004417:Dyspnea / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D010166:Palliative Care; D010821:Physicians, Family / Q000523:psychology; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*
D000701:Analgesics, Opioid; D002492:Central Nervous System Depressants