Breathlessness during the Last Week of Life in Palliative Care: An Australian Prospective, Longitudinal Study

M. Ekström, S.F. Allingham, K. Eagar, P. Yates, Claire Johnson, D.C. Currow

    Research output: Contribution to journalArticle

    12 Citations (Scopus)

    Abstract

    © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.Context Breathlessness is a major cause of suffering and distress, and little is known about the trajectory of breathlessness near death. Objectives To determine the trajectory and clinical-demographic factors associated with breathlessness in the last week of life in patients receiving specialist palliative care. Methods This was a prospective, longitudinal cohort study using national data on specialist palliative care from the Australian Palliative Care Outcomes Collaboration. We included patients in the Australian Palliative Care Outcomes Collaboration who died between July 1, 2013 and June 30, 2014 with at least one measurement of breathlessness on a 0-10 numerical rating scale in the week before death. The trajectory and factors associated with breathlessness were analyzed using multivariate random-effects linear regression. Results A total 12,778 patients from 87 services (33,404 data points) were analyzed. The average observed breathlessness was 2.1 points and remained constant over time. Thirty-five percent reported moderate to severe distress (numerical rating scale ≥4) at some time in their last week. Factors associated with higher breathlessness were younger age, male gender, cardiopulmonary involvement, concurrent fatigue, nausea, pain, sleeping problems, higher Australia-modified Karnofsky Performance Status, and clinical instability in the multivariate analysis. Respiratory failure showed the largest association (mean adjusted difference 3.1 points; 95% confidence interval, 2.8-3.4). Conclusion Although breathlessness has been reported to worsen in the last months, the mean severity remained stable in the final week of life. In specialized palliative care, one in three people experienced significant breathlessness especially in respiratory disease.
    Original languageEnglish
    Pages (from-to)816-823
    JournalJournal of Pain and Symptom Management
    Volume51
    Issue number5
    DOIs
    Publication statusPublished - 2016

    Fingerprint

    Palliative Care
    Dyspnea
    Longitudinal Studies
    Prospective Studies
    Karnofsky Performance Status
    Psychological Stress
    Respiratory Insufficiency
    Nausea
    Fatigue
    Linear Models
    Cohort Studies
    Multivariate Analysis
    Demography
    Confidence Intervals
    Pain

    Cite this

    Ekström, M. ; Allingham, S.F. ; Eagar, K. ; Yates, P. ; Johnson, Claire ; Currow, D.C. / Breathlessness during the Last Week of Life in Palliative Care: An Australian Prospective, Longitudinal Study. In: Journal of Pain and Symptom Management. 2016 ; Vol. 51, No. 5. pp. 816-823.
    @article{ad2646a304d341adbfc61edc3e414e6c,
    title = "Breathlessness during the Last Week of Life in Palliative Care: An Australian Prospective, Longitudinal Study",
    abstract = "{\circledC} 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.Context Breathlessness is a major cause of suffering and distress, and little is known about the trajectory of breathlessness near death. Objectives To determine the trajectory and clinical-demographic factors associated with breathlessness in the last week of life in patients receiving specialist palliative care. Methods This was a prospective, longitudinal cohort study using national data on specialist palliative care from the Australian Palliative Care Outcomes Collaboration. We included patients in the Australian Palliative Care Outcomes Collaboration who died between July 1, 2013 and June 30, 2014 with at least one measurement of breathlessness on a 0-10 numerical rating scale in the week before death. The trajectory and factors associated with breathlessness were analyzed using multivariate random-effects linear regression. Results A total 12,778 patients from 87 services (33,404 data points) were analyzed. The average observed breathlessness was 2.1 points and remained constant over time. Thirty-five percent reported moderate to severe distress (numerical rating scale ≥4) at some time in their last week. Factors associated with higher breathlessness were younger age, male gender, cardiopulmonary involvement, concurrent fatigue, nausea, pain, sleeping problems, higher Australia-modified Karnofsky Performance Status, and clinical instability in the multivariate analysis. Respiratory failure showed the largest association (mean adjusted difference 3.1 points; 95{\%} confidence interval, 2.8-3.4). Conclusion Although breathlessness has been reported to worsen in the last months, the mean severity remained stable in the final week of life. In specialized palliative care, one in three people experienced significant breathlessness especially in respiratory disease.",
    author = "M. Ekstr{\"o}m and S.F. Allingham and K. Eagar and P. Yates and Claire Johnson and D.C. Currow",
    year = "2016",
    doi = "10.1016/j.jpainsymman.2015.12.311",
    language = "English",
    volume = "51",
    pages = "816--823",
    journal = "Journal of Pain and Symptom Management:Including Supportive and Palliative Care",
    issn = "0885-3924",
    publisher = "Academic Press",
    number = "5",

    }

    Breathlessness during the Last Week of Life in Palliative Care: An Australian Prospective, Longitudinal Study. / Ekström, M.; Allingham, S.F.; Eagar, K.; Yates, P.; Johnson, Claire; Currow, D.C.

    In: Journal of Pain and Symptom Management, Vol. 51, No. 5, 2016, p. 816-823.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Breathlessness during the Last Week of Life in Palliative Care: An Australian Prospective, Longitudinal Study

    AU - Ekström, M.

    AU - Allingham, S.F.

    AU - Eagar, K.

    AU - Yates, P.

    AU - Johnson, Claire

    AU - Currow, D.C.

    PY - 2016

    Y1 - 2016

    N2 - © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.Context Breathlessness is a major cause of suffering and distress, and little is known about the trajectory of breathlessness near death. Objectives To determine the trajectory and clinical-demographic factors associated with breathlessness in the last week of life in patients receiving specialist palliative care. Methods This was a prospective, longitudinal cohort study using national data on specialist palliative care from the Australian Palliative Care Outcomes Collaboration. We included patients in the Australian Palliative Care Outcomes Collaboration who died between July 1, 2013 and June 30, 2014 with at least one measurement of breathlessness on a 0-10 numerical rating scale in the week before death. The trajectory and factors associated with breathlessness were analyzed using multivariate random-effects linear regression. Results A total 12,778 patients from 87 services (33,404 data points) were analyzed. The average observed breathlessness was 2.1 points and remained constant over time. Thirty-five percent reported moderate to severe distress (numerical rating scale ≥4) at some time in their last week. Factors associated with higher breathlessness were younger age, male gender, cardiopulmonary involvement, concurrent fatigue, nausea, pain, sleeping problems, higher Australia-modified Karnofsky Performance Status, and clinical instability in the multivariate analysis. Respiratory failure showed the largest association (mean adjusted difference 3.1 points; 95% confidence interval, 2.8-3.4). Conclusion Although breathlessness has been reported to worsen in the last months, the mean severity remained stable in the final week of life. In specialized palliative care, one in three people experienced significant breathlessness especially in respiratory disease.

    AB - © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.Context Breathlessness is a major cause of suffering and distress, and little is known about the trajectory of breathlessness near death. Objectives To determine the trajectory and clinical-demographic factors associated with breathlessness in the last week of life in patients receiving specialist palliative care. Methods This was a prospective, longitudinal cohort study using national data on specialist palliative care from the Australian Palliative Care Outcomes Collaboration. We included patients in the Australian Palliative Care Outcomes Collaboration who died between July 1, 2013 and June 30, 2014 with at least one measurement of breathlessness on a 0-10 numerical rating scale in the week before death. The trajectory and factors associated with breathlessness were analyzed using multivariate random-effects linear regression. Results A total 12,778 patients from 87 services (33,404 data points) were analyzed. The average observed breathlessness was 2.1 points and remained constant over time. Thirty-five percent reported moderate to severe distress (numerical rating scale ≥4) at some time in their last week. Factors associated with higher breathlessness were younger age, male gender, cardiopulmonary involvement, concurrent fatigue, nausea, pain, sleeping problems, higher Australia-modified Karnofsky Performance Status, and clinical instability in the multivariate analysis. Respiratory failure showed the largest association (mean adjusted difference 3.1 points; 95% confidence interval, 2.8-3.4). Conclusion Although breathlessness has been reported to worsen in the last months, the mean severity remained stable in the final week of life. In specialized palliative care, one in three people experienced significant breathlessness especially in respiratory disease.

    U2 - 10.1016/j.jpainsymman.2015.12.311

    DO - 10.1016/j.jpainsymman.2015.12.311

    M3 - Article

    VL - 51

    SP - 816

    EP - 823

    JO - Journal of Pain and Symptom Management:Including Supportive and Palliative Care

    JF - Journal of Pain and Symptom Management:Including Supportive and Palliative Care

    SN - 0885-3924

    IS - 5

    ER -