Dyspnea—Can we do more? A view from a tertiary hospital palliative care service

Abstract

Introduction: Dyspnea is often poorly controlled due to its multi-dimensional nature. Hospitalized in-patients with moderate or severe dyspnea at the start of a palliative care (PC) episode were profiled to determine their care needs.Methods: Seventy inpatients receiving care from a tertiary consultative PC service and with moderate to severe dyspnea were reviewed. Socio-demographics, clinical condition, and management during the PC episode were studied.Results: Most patients (92.9%) had multiple etiological causes for dyspnea. Many had 2 or more concomitant symptoms (72.9%) and the most common concomitant symptom was psycho-emotional distress (80.0%). Morphine (74.3%) was the most common medication received. Forty-three (61.4%) patients died within the same hospital admission. The mean length of hospital stay (HS) was 11.7 days with the mean length of PC review being 5.5 days (47.0% of HS). Time to PC was longer in patients who died in hospital (8.0 days) compared to patients who were discharged (3.4 days) (P = 0.05). At the end of the PC review, 66.7% of patients who were discharged alive had significant relief of their dyspnea.Discussion: Dyspnea in hospitalized dyspneic PC patients is commonly multi-etiological. Patients have multiple concomitant symptoms with a high mortality rate, suggesting that this group of patients have high care needs. There are implications on future research on developing inter-disciplinary fast track inpatient PC dyspnea intervention services.