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Dyspnea: Psychological Impact on Patients & Families & Health Care Providers

Dyspnea: Psychological Impact on Patients & Families & Health Care Providers. Larry Librach MD,CCFP,FCFP Professor, Dept. of Family & Community Medicine Sun Life Financial Chair in Bioethics & Director Joint Centre for Bioethics, University of Toronto

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Dyspnea: Psychological Impact on Patients & Families & Health Care Providers

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  1. Dyspnea: Psychological Impact on Patients & Families & Health Care Providers Larry Librach MD,CCFP,FCFP Professor, Dept. of Family & Community Medicine Sun Life Financial Chair in Bioethics & Director Joint Centre for Bioethics, University of Toronto QI Lead , TemmyLatner Centre for Palliative Care

  2. Importance • Perception of dyspnea is considered analogous to the perception of pain & consists of sensory (intensity) & affective (unpleasantness) dimensions • Similar cortical processes appear to underlie experience of dyspnea & pain

  3. Importance • Both symptoms result in added suffering • Anxiety, depression, & other psychological factors occur frequently in patients with advanced disease & influence breathlessness • Distressing symptom that requires attention, consideration, & treatment by healthcare providers

  4. Importance • HCPs are ethically obligated to treat dyspnea, & patients & their families should be reassured that they will be provided the means to effectively treat this symptom • Approach to care should be reflected in goals of care & care plan that involves a holistic approach

  5. Goals of Care for Dyspnea • Because patients do not experience dyspnea in isolation but rather in conjunction with other symptoms, concomitant stressors, & spiritual or existential distress • Dyspnea cannot be fully addressed unless these physical & nonphysical factors are understood.

  6. Psychological Impact

  7. Psychological Impact-Patient FEAR ! • Of suffocation • Added suffering • Added burden for family • Need for hastened death

  8. Neurophysiology • Anterior cingulate gyrus on cortex is area of brain that is responsible for emotional impact of physical symptoms like pain & dyspnea • Linked to thalamus by opioid sensitive pathway

  9. Psychological Impact-Patient • Manifestations include: • Anxiety • Panic • Poor sleep • Depression

  10. Psychological Impact-Patient • Opioids appropriate • Approach requires more than medication • Oxygen is not a panacea and may actually increase anxiety • Counselling important • Reassuring conversations & education • Outline expectations • Discuss continuing evaluation

  11. Psychological Impact-Family • Again fear of suffocation & witnessing an agonizing death • Sense of helplessness • Anxiety about the very end of life & whether hospital the best place

  12. Psychological Impact-Family • Approach requires regular visits, reassurance re: accessibility • Also reassurance re: role of oxygen as it is not a panacea

  13. Psychological ImpactHealth Care Providers • Sense of “need to do something” • Anxiety around need for oxygen • Foreboding about suffocation • Anxiety around when to institute sedation

  14. Summary • Dyspnea is a common symptom in palliative care • Induces great fear • Success is most likely when as many as possible of the patient’s individual dyspnea stressors & concomitant symptoms (i.e., anxiety, depression, panic attacks) are identified & addressed

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