What influences the presentation of patients with chronic breathlessness to the Emergency Department? A mixed methods study

Background: Chronic breathlessness is a common and distressing symptom of many long-term cardiorespiratory conditions and cancers which are highly prevalent in both the UK and worldwide. It is associated with presentation to the emergency department (ED) and admission to hospital.Aim: The aim of this research is to improve our understanding of the role of chronic breathlessness in ED presentations by people with advanced cardiorespiratory disease and to identify potential targets for interventions to prevent or avoid emergency presentations.Methods: Mixed methods study with integration of findings at analysis. A systematic review and qualitative synthesis were performed to examine the literature on the experience of breathlessness. A prospective survey and case note review were conducted to establish the prevalence of presentations due to acute-on-chronic breathlessness at the ED and to identify the demographic and clinical characteristics of those patients. The perceptions of patients with chronic breathlessness, their carer and healthcare professionals regarding presentation to the ED due to acute-on-chronic breathlessness were explored by semi-structured interview.Findings: Living with chronic breathlessness involves widespread effects on the lives of both the patient and those caring for them, yet this impact may remain largely invisible to others. Quality of life with chronic breathlessness is maximised by a patient’s engaged coping style and a clinician’s responsiveness to breathlessness as well as to the underlying disease. This is described by the Breathing Space concept. Presentation to the ED sits within this context and occurs as a result of a breathlessness crisis. There are a proportion of patients who may have avoidable attendances and could be more optimally managed in the community.Conclusions: Greater public and professional understanding of the widespread effects of breathlessness, combined with appropriate assessment and management of the symptom, including planning for crisis may reduce the need to present to the ED.

Name dc:type.qualificationname

PhD in Medical Sciences

Level dc:type.qualificationlevel

PhD

Grantor dc:publisher.institution

University of Hull

Year dc:date.issued

2017

Author dc:creator

• Hutchinson, Ann

Advisor dc:contributor.advisor

• Miriam Johnson, Alastair Pickering

Language dc:language

en

Identifier

oai:hull-repository.worktribe.com:497045

OAI identifier oai:identifier

oai:hull-repository.worktribe.com:497045