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Volpato E, Banfi P, Nicolini A, Pagnini F. A quick relaxation exercise for people with chronic obstructive pulmonary disease: explorative randomized controlled trial. Multidiscip Respir Med 2018; 13:13. [PMID: 29744054 PMCID: PMC5932751 DOI: 10.1186/s40248-018-0124-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background People with Chronic Obstructive Pulmonary Disease (COPD) suffer from dyspnoea, which may be increased by anxiety. Previous studies suggest that relaxation techniques may have positive effects in pulmonary rehabilitation. The main aim of this study is to explore the clinical impact of a quick, one-session, relaxation training for people with COPD. Methods In this perspective, 38 participants with COPD were recruited and randomly assigned to listen to a relaxing audio or to watch a neutral stimulus, during their routine exams. Participants were assessed for psychological and physiological variables, analysed through non-parametric tests. Results Those who joined the relaxation training showed more positive outcomes about respiratory and cardiac assessments, as well as for state anxiety and positive affections, in comparison with the baseline and the control group. Conclusions Study results suggest that relaxation has a potential to produce improvements in respiratory and cardiac functions, together with a positive emotional effect and a reduction of anxiety. Trial registration ClinicalTrials.gov ID: NCT02698904. Record Registration: February 2016.
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Affiliation(s)
- Eleonora Volpato
- 1Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, Milan, Italy.,IRCCS Santa Maria Nascente, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Paolo Banfi
- IRCCS Santa Maria Nascente, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Antonello Nicolini
- Unità di Riabilitazione Respiratoria, ASL 4 Chiavarese, Ospedale di Sestri Levante, Sestri Levante, Italy
| | - Francesco Pagnini
- 1Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, Milan, Italy.,4Department of Psychology, Harvard University, Cambridge, MA USA
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Moody LE, Beckie T, Long C, Edmonds A, Andrews S. Assessing Readiness for Death in Hospice Elders and Older Adults. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/0742-969x.2000.11882952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Weitzner MA, Moody LN, McMillan SC. Symptom management issues in hospice care. Am J Hosp Palliat Care 2016. [DOI: 10.1177/104990919701400407] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Michael A. Weitzner
- Psychiatry Service, Psychosocial Oncology Program, H. Lee Moffitt Cancer Center, University of South Florida College of Medicine, Tampa, Florida
| | - Linda N. Moody
- University of South Florida College of Nursing, Tampa, Florida
| | - Susan C. McMillan
- American Cancer Society, University of South Florida College of Nursing, Tampa, Florida
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Relaxation Techniques for People with Chronic Obstructive Pulmonary Disease: A Systematic Review and a Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:628365. [PMID: 26339268 PMCID: PMC4539049 DOI: 10.1155/2015/628365] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/28/2015] [Indexed: 11/17/2022]
Abstract
Introduction. Chronic Obstructive Pulmonary Disease (COPD) people suffer from severe physical impairments, which often elicit significant psychological distress and impact their quality of life. This meta-analysis aimed to assess evidence from the scientific literature on the effects of relaxation techniques. Methods. We investigated 9 databases to select 25 RCTs. Studies included both inpatients and outpatients with COPD. Both respiratory and psychological outcomes were considered. Results. Relaxation techniques showed a little positive effect on the value of the percentage of predicted FEV1 (d = 0.20; 95% Cl: 0.40--0.01) as well as a slight effect on levels of both the anxiety (d = 0.26; 95% Cl: 0.42-0.10) and depression (d = 0.33; 95% Cl: 0.53-0.13). The higher effect size was found in the quality of life value (d = 0.38; 95% Cl: 0.51-0.24). The assessed quality of the studies, based on the PEDro Scale, was generally medium/high. Conclusion. Relaxation training can have a moderate impact on both psychological well-being and respiratory function, resulting in noticeable improvements in both. Although higher quality research is required, our results sustain the importance of relaxation techniques as a tool to manage COPD.
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Bausewein C, Booth S, Gysels M, Higginson IJ. WITHDRAWN: Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases. Cochrane Database Syst Rev 2013; 2013:CD005623. [PMID: 24272974 PMCID: PMC6564079 DOI: 10.1002/14651858.cd005623.pub3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review is now out of date although it is correct as of the date of publication [Issue 2, 2008]. The authors are developing a new protocol which will replace this review. Publication of the protocol is expected in 2014, and serves to update the existing review and incorporate the latest evidence into a new Cochrane Review. The latest version of this review (available in 'Other versions' tab on The Cochrane Library) may still be useful to readers until the new review is published. In 2016, the replacement review titled 'Non‐pharmacological interventions for breathlessness in advanced stages of malignant and non‐malignant diseases' was deregistered and split into four separate reviews of individual interventions: Respiratory interventions for breathlessness in adults with advanced diseases; Physical interventions for breathlessness in adults with advanced diseases; Cognitive‐emotional interventions for breathlessness in adults with advanced diseases; Multi‐dimensional interventions for breathlessness in adults with advanced diseases. At September 2020, these replacement titles were deregistered (Multi‐dimensional interventions) or the protocols withdrawn (Cognitive‐emotional interventions; Multi‐dimensional interventions; Respiratory interventions) as they did not meet Cochrane standards or expectations. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Claudia Bausewein
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Kings College London, Bessemer Road, Denmark Hill, London, UK, SE5 9PJ
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Menzies V, Jallo N. Guided imagery as a treatment option for fatigue: a literature review. J Holist Nurs 2011; 29:279-86. [PMID: 21772047 DOI: 10.1177/0898010111412187] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Fatigue is one of the most common complaints experienced among the general population. Because fatigue is recognized as a biobehavioral occurrence, a biobehavioral intervention such as guided imagery may be effective in reducing self-reported fatigue. Therefore, the purpose of this study was to explore the research literature related to the use of guided imagery as a nonpharmacological mind-body intervention for the symptom of fatigue. METHOD The electronic databases MEDLINE, CINAHL, PsychInfo, Psychology and Behavioral Sciences Collection and the Cochrane Library were searched from January 1980 to June 2010. FINDINGS Of 24 articles retrieved, eight met the inclusion criteria and were included in this systematic literature review. FINDINGS were inconsistent regarding the effectiveness of guided imagery on fatigue. Studies varied in study length, duration of the applied guided imagery intervention, dosage, and whether the images were targeted to the purpose of the intervention. IMPLICATIONS Guided imagery is a simple, economic intervention with the potential to effectively treat fatigue, thus further research is warranted using systematic, well-designed methodologies Standardizing guided imagery interventions according to total duration of exposure and targeted imagery in a variety of different populations adequately powered to detect changes will contribute to and strengthen nursing's symptom-management armamentarium.
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Lai WS, Chao CSC, Yang WP, Chen CH. Efficacy of guided imagery with theta music for advanced cancer patients with dyspnea: a pilot study. Biol Res Nurs 2010; 12:188-97. [PMID: 20453018 DOI: 10.1177/1099800409347556] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dyspnea is a frequent and devastating symptom among advanced cancer patients for which improved and low-cost palliative techniques are needed. METHODS A one-group repeated measures research design investigated the efficacy of guided imagery (GI) with theta music (M) on dyspnea in advanced cancer patients. The intervention consisted of four periods: (a) pretest; (b) intervention with peaceful non-M; (c) intervention with 10 min of GI with M (GI/M), with the first and last 3 min being M only (i.e., the middle 4 min was GI/M); and (d) posttest. Dyspnea outcome was measured with the Modified Borg Scale (MBS) for self-reported evaluation of dyspneic symptoms. Physiological parameters measured were pulse oxygen saturation (SpO(2)), end-tidal CO( 2) (EtCO(2)), heart rate (HR), and respiratory rate (RR). Posttest qualitative data were obtained via interview for subjective patient experience. RESULTS Participants included 53 patients, 33% with lung cancer. GI/M produced a significant decrease in MBS scores; 90% of the subjects gave positive qualitative reviews of GI/M. SpO(2) did not change significantly over time. GI/M significantly increased EtCO(2), decreased RR, and decreased HR. DISCUSSION This study demonstrates that GI/M is a useful intervention for palliative care of patients with dyspnea. M alone was demonstrated to be effective, while soothing non-M was not effective. GI/M was more effective than M alone. GI/M should be considered low-cost end-of-life palliative care for dyspnea.
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Affiliation(s)
- Wei-Shu Lai
- Institute of Allied Health Sciences, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
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Abstract
BACKGROUND Bronchiectasis is a common respiratory disease, especially in developing countries. Its cause varies from chronic infection to rare immune deficiencies. Bronchiectasis can be present with other respiratory diseases, such as chronic obstructive pulmonary disease (COPD). People with bronchiectasis may suffer from chronic cough, fatigue, shortness of breath, chest pain and coughing up blood. Their lung function may decline with time. These can also have a negative impact on their quality of life. Thus, a holistic management is needed to provide treatment and support. Therapies which include breathing manoeuvres, such as singing, may have health benefits for respiratory function and psychological well being. OBJECTIVES To evaluate the effects of a singing intervention as a therapy on the quality of life, morbidity, respiratory muscle strength and pulmonary function of children and adults with bronchiectasis. SEARCH STRATEGY We searched the Cochrane Airways Group (CAG) trials register, the Cochrane Central Register of Controlled Trials, major allied complementary databases, and clinical trials registers. Professional organisations and individuals were also contacted. CAG performed searches in February, and additional searches were carried out in June 2009. SELECTION CRITERIA Randomised controlled trials in which singing (as an intervention) is compared with either a sham intervention or no singing in patients with bronchiectasis. DATA COLLECTION AND ANALYSIS Two authors independently reviewed the titles, abstracts and citations to assess potential relevance for full review. No eligible trials were identified and thus no data were available for analysis. MAIN RESULTS No meta-analysis could be performed. AUTHORS' CONCLUSIONS In the absence of data, we cannot draw any conclusion to support or refute the adoption of singing as an intervention for people with bronchiectasis. Given the simplicity of the potentially beneficial intervention, future randomised controlled trials are required to evaluate singing therapy for people with bronchiectasis.
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Affiliation(s)
- Jung Yoon Irons
- Sydney Conservatorium of Music, University of SydneyAustralian Centre for Applied Research in Music PerformanceCnr Bridge & Macquarie StreetsSydneyNew South WalesAustralia2000
| | - Dianna Theadora Kenny
- University of SydneyBehavioural and Social Sciences in Health, Faculty of Health SciencesEast StLidcombeNSWAustralia1825
| | - Anne B Chang
- Queensland Children's Respiratory Centre and Queensland Children's Medical Research InstituteRoyal Children's Hospital, Brisbane and Menzies School of Health Research, CDU, DarwinHerston RoadHerstonBrisbaneQueenslandAustralia4029
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Bausewein C, Booth S, Gysels M, Higginson I. Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases. Cochrane Database Syst Rev 2008:CD005623. [PMID: 18425927 DOI: 10.1002/14651858.cd005623.pub2] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Breathlessness is a common and distressing symptom in the advanced stages of malignant and non-malignant diseases. Appropriate management requires both pharmacological and non-pharmacological interventions. OBJECTIVES The primary objective was to determine the effectiveness of non-pharmacological and non-invasive interventions to relieve breathlessness in participants suffering from the five most common conditions causing breathlessness in advanced disease. SEARCH STRATEGY We searched the following databases: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, British Nursing Index, PsycINFO, Science Citation Index Expanded, AMED, The Cochrane Pain, Palliative and Supportive Care Trials Register, The Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effectiveness in June 2007. We also searched various websites and reference lists of relevant articles and textbooks. SELECTION CRITERIA We included randomised controlled and controlled clinical trials assessing the effects of non-pharmacological and non-invasive interventions to relieve breathlessness in participants described as suffering from breathlessness due to advanced stages of cancer, chronic obstructive pulmonary disease (COPD), interstitial lung disease, chronic heart failure or motor neurone disease. DATA COLLECTION AND ANALYSIS Two review authors independently assessed relevant studies for inclusion. Data extraction and quality assessment was performed by three review authors and checked by two other review authors. Meta-analysis was not attempted due to heterogeneity of studies. MAIN RESULTS Forty-seven studies were included (2532 participants) and categorised as follows: single component interventions with subcategories of walking aids (n = 7), distractive auditory stimuli (music) (n = 6), chest wall vibration (CWV, n = 5), acupuncture/acupressure (n = 5), relaxation (n = 4), neuro-electrical muscle stimulation (NMES, n = 3) and fan (n = 2). Multi-component interventions were categorised in to counselling and support (n = 5), breathing training (n = 3), counselling and support with breathing-relaxation training (n = 2), case management (n = 2) and psychotherapy (n = 2). There was a high strength of evidence that NMES and CWV could relieve breathlessness and moderate strength for the use of walking aids and breathing training. There is a low strength of evidence that acupuncture/acupressure is helpful. There is not enough data to judge the evidence for distractive auditory stimuli (music), relaxation, fan, counselling and support, counselling and support with breathing-relaxation training, case management and psychotherapy. Most studies have been conducted in COPD patients, only a few studies included participants with other conditions. AUTHORS' CONCLUSIONS Breathing training, walking aids, NMES and CWV appear to be effective non-pharmacological interventions for relieving breathlessness in advanced stages of disease.
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Affiliation(s)
- C Bausewein
- King's College London, Department of Palliative Care, Policy & Rehabilitation, Weston Education Centre, Denmark Hill, London, UK, SE5 9RJ.
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McMillan SC, Small BJ. Using the COPE intervention for family caregivers to improve symptoms of hospice homecare patients: a clinical trial. Oncol Nurs Forum 2007; 34:313-21. [PMID: 17573295 DOI: 10.1188/07.onf.313-321] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To test an intervention for hospice caregivers designed to help them better manage symptoms experienced by patients with cancer. DESIGN A three-group comparative design with repeated measures. SETTING A large nonprofit hospice that primarily provides home care. SAMPLE 329 hospice homecare patients with cancer and their caregivers were randomized into three groups: a control group (n = 109) receiving standard care, a group (n = 109) receiving standard care plus friendly visits, and a group (n = 111) receiving standard care plus the COPE intervention. METHODS Caregivers received experimental training in the COPE intervention (creativity, optimism, planning, expert information) over nine days to assist with symptom management. MAIN RESEARCH VARIABLES Intensity of pain, dyspnea, and constipation, overall symptom distress, and quality of life (QOL). Data were collected on admission and days 16 and 30. FINDINGS Although symptom intensity for three target symptoms did not decrease, symptom distress was significantly improved (p = 0.009) in the COPE intervention group. QOL was not significantly different. CONCLUSIONS Symptom distress, a measure that encompasses patient suffering along with intensity, was significantly decreased in the group in which caregivers were trained to better manage patient symptoms. IMPLICATIONS FOR NURSING The COPE intervention is effective and immediately translatable to the bedside for hospice homecare patients with advanced cancer.
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Affiliation(s)
- Susan C McMillan
- College of Nursing, University of South Florida, Tampa, FL, USA.
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Scarpaci LT, Tsoukleris MG, McPherson ML. Assessment of Hospice Nurses' Technique in the Use of Inhalers and Nebulizers. J Palliat Med 2007; 10:665-76. [PMID: 17592978 DOI: 10.1089/jpm.2006.0180] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Dyspnea, a common distressing end-of-life symptom, is treated with oral (i.e., opioids and anxiolytics) and inhaled medications (anti-inflammatory and bronchodilator agents). Health care providers and patients have demonstrated an inability to use inhaler devices correctly, which can lead to suboptimal drug delivery and poor symptom relief. Hospice nurses are the primary health care providers educating patients, making it critical that they convey accurate device technique. This study assessed hospice nurses' ability to demonstrate proper inhaler device technique and their knowledge of agents used to treat dyspnea. Forty-seven nurses participated. Participants completed a written questionnaire, which gathered demographic data, as well as information regarding previous training with an inhaler device, administration, pharmacokinetics, mechanism of action, patient assessment, and nursing technique. Additionally, each nurse demonstrated the use of a metered dose inhaler, spacer, dry powder inhaler, and a nebulizer, while being observed by a pharmacist trained in the use of inhalers. A standardized evaluation form was used to ensure consistency between evaluators and subjects. Percentage of steps completed correctly by the study participants ranged from 34.9% with the dry powder inhaler to 67.6% with the metered dose inhaler. Years of experience, presence of hospice certification, personal use of inhaler, and nursing comfort level significantly impacted ability to use inhalation devices. This study demonstrated the existence of knowledge gaps regarding patient assessment, pharmacology and pharmacokinetics of inhaled medications, and inhalation device technique among hospice nurses. Formal education of hospice practitioners regarding inhaled medications and inhalation delivery devices is needed.
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Affiliation(s)
- Laura T Scarpaci
- excelleRx, Inc., An Omnicare Company, Philadelphia, Pennsylvania, USA
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Abstract
The aim of this study was to explore the effects of guided imagery relaxation in people with chronic obstructive pulmonary disease (COPD) using a randomized controlled design. Half of 26 participants were allocated to the treatment group in which six practice sessions on guided imagery were conducted, while the control group was instructed to take rest quietly during the six sessions. At the seventh session, physiological changes: partial percentage of oxygen saturation; heart rate; upper thoracic surface electromyography; skin conductance; and peripheral skin temperature were recorded during a 30-minute session with a sampling frequency of one minute. Repeated measures analysis of variance was used to explore the changes of the parameters between the groups. Mann-Whitney U test was used to compare the change of perceived dyspnoea between the groups. Results showed there was a statistically significant (p < 0.05) increase in partial percentage of oxygen saturation in the treatment group, but no significant effects on the other physiological parameters. Further study exploring the psychological effects of guided imagery is suggested.
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Abstract
The purpose of this study was to determine the effects of relaxation and imagery on the sleep of critically ill adults. The study was an experimental clinical trial with random assignment to two groups. Analysis used repeated measures ANOVA. Thirty-six adults (17 males and 19 females) with a variety of physical diagnoses in three critical-care units in two large metropolitan hospitals were studied. Outcome measures were scores on a visual analog sleep scale, measured on three mornings. The intervention was a combination of relaxation and imagery, delivered on two evenings. All subjects' sleep improved over time. There were significant interaction effects between the intervention, gender, and time, with males' scores improving rapidly, and females' scores first dropping, then improving rapidly. A combination of relaxation and imagery is effective in improving the sleep of the critically ill adult, with men responding immediately to relaxation and imagery with improved sleep, and women taking more time to respond to the intervention.
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Affiliation(s)
- Stephanie Richardson
- College of Nursing, Center for Teaching and Learning Excellence, University of Utah, Salt Lake City 84112-0511, USA.
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Moody LE, McMillan S. Dyspnea and quality of life indicators in hospice patients and their caregivers. Health Qual Life Outcomes 2003; 1:9. [PMID: 12740034 PMCID: PMC155633 DOI: 10.1186/1477-7525-1-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2003] [Accepted: 04/17/2003] [Indexed: 11/20/2022] Open
Abstract
This study describe the assessment of dyspnea, symptom distress, and quality of life measures in 163 hospice patients with cancer who reported dyspnea. Mean age of the hospice patient sample was 70.22 years and 61.86 for caregivers (65% were spouses). The majority of patients and caregivers were white: 87%, 63% of the patients were male while 78% of caregivers were female. Mean dyspnea intensity as reported by patients was 4.52 (SD 2.29) and caregivers, 4.39 (SD 2.93). Patients' and caregivers' ratings of the patient's dyspnea intensity revealed no significant differences in ratings thus verifying that caregivers can assess dyspnea severity accurately. Patients' perceived quality of life ratings were not significantly correlated with ratings of their caregivers' perceived quality of life. For patients, symptom distress and education were significant predictors of variance in quality of life (R2 =.35, p =.04). However, mastery, symptom distress, age, and education were found to be significant predictors of variance in quality of life of caregivers (R2 =.40, p =.02).
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Affiliation(s)
- Linda E Moody
- University of South Florida, College of Nursing,12901 Bruce B. Downs Blvd., MDC 22, Tampa, FL 33612
| | - Susan McMillan
- University of South Florida, College of Nursing,12901 Bruce B. Downs Blvd., MDC 22, Tampa, FL 33612
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Abstract
The purpose of this Study was to describe the experience of participating in Interactive Guided Imagery (IGI) from the perspective of clients. A qualitative descriptive design guided the research. Ten clients who had engaged in IGI, each with an R.N., IGI-certified practitioner, composed the sample. To explore participants' perceptions of their IGI experience, data were gathered through semistructured, in-depth interviews. Data analysis was carried out through data coding, categorizing, and subcategorizing; thematic synthesis; and structuring of relationships. Six primary themes emerged to compose the description of the experience of participating in IGI: the client's lived experience, use of a nonordinary state of consciousness, the guide, the guide-client relationship, influencing factors, and the results of IGI use. Based on the primary themes and their interrelationships, a model of the IGI experience was developed. The description and the model of the IGI experience provide the basis for further nursing knowledge development of the IGI modality.
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McMillan SC, Small BJ. Symptom distress and quality of life in patients with cancer newly admitted to hospice home care. Oncol Nurs Forum 2002; 29:1421-8. [PMID: 12432413 DOI: 10.1188/02.onf.1421-1428] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate the relationships between quality of life (QOL) and symptom distress, pain intensity, dyspnea intensity, and constipation intensity in people with advanced cancer who were newly admitted to hospice home care. DESIGN Descriptive and correlational. SETTING A large hospice that provides primarily home care. SAMPLE 178 adult hospice homecare patients with cancer who were accrued to a clinical trial funded by the National Institutes of Health focusing on symptom management and QOL. Patients were excluded if they received a score lower than seven on the Short Portable Mental Status Questionnaire. METHOD The patients were invited to participate in the clinical trial within 48 hours of admission to hospice home care. Among the questionnaires they completed were a QOL index and a distress scale. Scales measuring present intensity of pain, dyspnea, and constipation also were administered. MAIN RESEARCH VARIABLES QOL, symptom distress, pain intensity, dyspnea intensity, and constipation intensity. FINDINGS The most frequently reported symptoms among the sample were lack of energy, pain, dry mouth, and shortness of breath. Lack of energy caused the greatest distress, followed closely by dry mouth and pain. The results of the regression analysis indicated that total distress score, pain intensity, dyspnea intensity, and constipation intensity were related to QOL at the univariate level. When all predictors were considered simultaneously, only the total distress score remained a significant predictor of QOL (p< 0.001), accounting for about 35% of variance. CONCLUSIONS QOL was affected by symptom distress in people with advanced cancer near the end of life. IMPLICATIONS FOR NURSING The symptoms most commonly reported and those that cause the greatest patient distress should be addressed first by hospice nurses. Continued effort is needed in the important area of symptom management.
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Affiliation(s)
- Susan C McMillan
- College of Nursing, University of South Florida, Tampa, FA, USA.
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Abstract
Dyspnea, like pain, is a subjective experience that incorporates physical elements and affective components. Management of breathlessness in patients with cancer requires expertise that includes an understanding and assessment of the multidimensional components of the symptom, knowledge of the pathophysiologic mechanisms and clinical syndromes that are common in cancer, and familiarity with the indications and limitations of the available therapeutic approaches. Relief of breathlessness should be the goal of treatment at all stages of cancer. Good control of dyspnea will improve the patient's quality of life.
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Affiliation(s)
- Deborah J Dudgeon
- Palliative Care Medicine Program, Queen's University, Room 2025, Etherington Hall, 94 Stuart Street, Kingston, Ontario, Canada K7L 3N6.
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Webb M, Moody LE, Mason LA. Dyspnea assessment and management in hospice patients with pulmonary disorders. Am J Hosp Palliat Care 2000; 17:259-64. [PMID: 11883802 DOI: 10.1177/104990910001700412] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Accurate assessments and appropriate management of dyspnea are essential to provide improved quality of life for hospice patients. This study describes methods of assessing dyspnea and interventions used to manage dyspnea in 72 hospice patients with end-stage lung disease or lung cancer. The mean age of the sample was 72.46 years old and the majority was white (80 percent) and male (62 percent). Paired t-tests were used to compare mean scores on admission and near death for dyspnea severity, Karnofsky functional status, pain, and Mini-Mental Status scores. Results showed significant decline in functional and cognitive status, but no significant changes in dyspnea severity and pain. Dyspnea was often assessed subjectively with observational methods only. Use of inhalants, oxygen, positioning, steroids, and oral opioids were the most frequent therapies for dyspnea. Relaxation, guided imagery, and other complementary therapies were rarely used (five percent or less). Measurement of dyspnea needs to be done frequently by using standardized instruments to assess severity and degree of symptom distress as well as the effects of treatment. Clinical trials are needed to determine which dyspnea interventions are most effective in terminally ill patients. Guidelines such as those developed for pain management are needed for effectively managing dyspnea.
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Affiliation(s)
- M Webb
- University of South Florida, College of Nursing, Tampa, USA
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Abstract
Evidence is accumulating that mental and emotional processes can affect disease states. Mind-body therapies are effective adjuncts to conventional medical treatments, and they are easy to teach and learn. This article offers a review of relevant literature and introduces several mind-body techniques.
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Affiliation(s)
- D R Chiarmonte
- Maxton Family Practice, Maxton, North Carolina 28364, USA
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Affiliation(s)
- M A Weitzner
- Psychiatry Service, H. Lee Moffitt Cancer Center, University of South Florida College of Medicine, Tampa, USA
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Abstract
Alternative therapies have gained increasing recognition and usage in North America during the past decade. In a descriptive study with a convenience sample of 213 Mexican Americans, three research questions were asked: (1) What specific kinds of alternative therapies do Mexicans in the Rio Grande Valley use? (2) What percentage of the sample group uses alternative therapies? and (3) Do the users of alternative therapies self-report these visits to their established, conventional, primary health care provider? Findings showed that 44% of respondents had used an alternative practitioner one or more times during the previous year. The most commonly sought therapies were herbal medicine, spiritual healing and prayer, massage, relaxation techniques, chiropractic, and visits to a curandero (Mexican folk healer). The majority (66%) never report visits to alternative practitioners to their established primary health provider.
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Affiliation(s)
- L Keegan
- University of Texas Health Science Center, San Antonio, USA
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Devine EC, Pearcy J. Meta-analysis of the effects of psychoeducational care in adults with chronic obstructive pulmonary disease. PATIENT EDUCATION AND COUNSELING 1996; 29:167-178. [PMID: 9006233 DOI: 10.1016/0738-3991(96)00862-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Meta-analysis, a quantitative research review, was conducted on 65 studies of the effect of education, exercise and/or psychosocial support (hereafter called psychoeducational care) in adults with chronic obstructive pulmonary disease (COPD). Studies ranged in publication date from 1954 to 1994. Only 34% of studies had subjects that were randomly assigned to treatment condition, and only 15% of studies had a placebo-type control group. Analyses by type of treatment showed that pulmonary rehabilitation (large muscle exercise and education plus a variety of psychosocial or behavioral interventions) had statistically significant beneficial effects on psychological well-being (d+ = 0.58, n = 13), endurance (d+ = 0.77, n = 13), functional status (d+ = 0.63, n = 8), VO2 (d+ = 0.56, n = 5), dyspnea (d+ = 0.71, n = 10), and adherence (d+ = 1.76, n = 2). A statistically significant beneficial effect of pulmonary rehabilitation was not found on Forced Expiratory Volume at 1 s. Across 7 outcomes examined, treatments including education-alone had significant beneficial effect on the accuracy of performing inhaler skills (d+ = 1.27, n = 7). Based on a very small sample of studies, a non-significant but small or medium sized effect of education-alone was evident on health care utilization (d+ = 0.26, n = 3) and on adherence to treatment regimen (d+ = 0.50, n = 2). Such results are inconclusive, suggesting that further research may be indicated. Relaxation-alone had statistically significant beneficial effects on both dyspnea (d+ = 0.91, n = 3) and psychological well-being (d+ = 0.39, n = 6). The research base has methodological weaknesses that should be rectified in future research. Nonetheless, based on the best evidence available to date, identified types of psychoeducational care have been shown to improve the functioning and well-being of adults with COPD.
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Affiliation(s)
- E C Devine
- School of Nursing, University of Wisconsin-Milwaukee 53201, USA.
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