None listed
Conditions
Brief summary
In settings of care for people who cannot breathe without support such as intensive care units (ICU), dyspnoea (the experience of difficulty breathing) is a frequent and terrifying problem. Recent reports indicate that dyspnoea in the ICU is just as commonly experienced as pain (47% report mod-severe dyspnoea vs 41% pain, n=138 ICU patients [Gentzler et al. 2019]), yet dyspnoea by comparison is poorly recognised, underassessed and under-treated. This results in increased length of ICU stay, poorer physical and long-term psychological outcomes; and occurs despite the availability of potentially suitable assessment tools and evidence-based effective interventions for dyspnoea in the ICU. Implementation of dyspnoea assessment and management in Australian ICUs is largely unexplored. This project aims to address explore this issue through two research questions: 1. What are the perceptions and beliefs of Australian ICU clinicians about dyspnoea assessment and management in patients in the ICU setting? 2. What is the experience of dyspnoea in people who have been cared for within an ICU environment? Methodology: The project will be conducted in two parts within an action research framework: 1. A cross-sectional national descriptive survey of medical, nursing and allied health clinicians working within Australian ICU’s, to explore attitudes and practices in dyspnoea assessment and management. 2. Semi-structured interviews with a purposive sample of ICU patients from a local facility, to explore the experience of breathlessness in people who have been cared for within the ICU environment. Significance: Internationally, addressing assessment and management of dyspnoea in ICU settings has been recognised as an ethical and moral imperative to lessen suffering, improve patient outcomes, and reduce health care costs associated with delayed time in the ICU and post-ICU morbidity. To date, there is no Australian data available on prevalence, assessment practices and management strategies on dyspnoea within the ICU setting. This study aims to gain an understanding of current Australian practice using a collaborative participatory action research approach to focus on patient and clinician-valued priorities and solutions. The findings from this study will provide a foundation for developing strategies to translate breathlessness science and evidence-based interventions into clinical practice in the ICU.
Interventions
Study Part 1– Cross-sectional National Descriptive Clinician Survey.
Medical, nursing and allied health staff of Australian adult ICU’s will be invited to participate in a single survey (approximately 15mins in duration) exploring their perceptions regarding assessment and management of breathlessness. Survey questions will be based on existing published surveys used to assess attitudes toward dyspnoea assessment and management in doctors and ICU nurses. Questions include non-identifiable demogr
Study Part 1– Cross-sectional National Descriptive Clinician Survey. Medical, nursing and allied health staff of Australian adult ICU’s will be invited to participate in a single survey (approximately 15mins in duration) exploring their perceptions regarding assessment and management of breathlessness. Survey questions will be based on existing published surveys used to assess attitudes toward dyspnoea assessment and management in doctors and ICU nurses. Questions include non-identifiable demographic data, and Likert-style statements inviting respondents to indicate their level of agreement concerning the importance of dyspnoea in clinical care; current assessment and management of dyspnoea; use and benefits of routine dyspnoea assessment; management of dyspnoea. In order to develop a ‘knowledge bank’, open-ended question responses will also be included, inviting responders to provide information on any strategies they have found personally useful for managing dyspnoea. We propose to reach the target population for this study through collaboration with both the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group (CTG), and the Cardiothoracic Special Interest Group of the Australian Physiotherapy Association. Study Part 2 - Interviews with consumers. A purposive sample of patients admitted to the ICU with and without respiratory disease (n=20 patients) over a four-month period will be recruited. Clinical staff at The Queen Elizabeth Hospital, South Australia (TQEH) will screen ICU patients Monday to Friday meeting the inclusion criteria. The aim of the interview is to explore the experience of breathlessness in people who have been cared for within the ICU environment. A topic guide will be developed based on previous interview studies and in conjunction with local consumer representatives who are part of the study reference group. The interview will be conducted on the day of ICU discharge or as close as practical. It will be a maximum of 30 minutes duration (interview can be offered as 2 shorter sessions if appropriate) and consist of 3 to 5 key questions specific to the participants ICU experience with prompts for experiences of symptoms of breathlessness. Post-study reference group: At the end of the interview, participants will be provided with an option to join a post-study reference group, to consider and reflect upon the study findings. This would involve further communication by telephone and email with the study investigators on a maximum of 2 occasions (for approx. 30mins) after analysis of the data. Interested participants would be invited to collaborate with interpretation of study results and development of proposed actions and recommendations from the study findings.
Sponsors
Mr Leigh Rushworth
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Survey Medical, nursing and allied health staff of Australian adult ICU’s will be invited to participate in a single survey. With endorsement of the study by the ANZICS CTG we anticipate the survey will be able to be distributed to over 70 ANZICS CTG member ICU’s in Australia, reaching a minimum of 500 eligible clinicians on the CTG mailing list. Mailing list recipients will be encouraged to forward the survey invitation to eligible clinicians within their networks (snowballing). Interviews A purposive sample of patients admitted to the ICU with and without respiratory disease (n=20 patients) over a four-month period will be recruited. Clinical staff at The Queen Elizabeth Hospital, South Australia (TQEH) will screen ICU patients Monday to Friday for the following inclusion criteria: • Aged over 18 years • English speaking • ICU stay of >48 hours • Planned for discharge from the ICU to the ward • Capacity to provide consent to participate Patients meeting the above inclusion criteria will be asked a single screening question - “Did you ever feel breathless during your time in ICU?”. Those indicating ‘yes’ will be invited to participate in a semi-structured interview.
Exclusion criteria
No specific groups are to be excluded.
Outcome results
None listed