Abstract
Background: Chronic breathlessness is a disabling syndrome that profoundly impacts patients’ and caregivers’ lives. Driving is important for most people, including those with advanced disease. Regular, low-dose, sustained-release morphine safely reduces breathlessness, but little is known about its impact on driving. Aim: To understand patients’ and caregivers’ (1) perspectives and experiences of driving with chronic breathlessness; and (2) perceived impact of regular, low-dose, sustained-release morphine on driving. Design: A qualitative study embedded in a pragmatic, phase III, randomised, placebo-controlled trial of low-dose, sustained-release morphine (⩽32 mg/24 h) for chronic breathlessness. Semi-structured interviews were conducted immediately after participants withdrew or completed the randomised, placebo-controlled trial. Informed by grounded theory, a constant comparative approach to analysis was adopted. Setting/participants: Participants were recruited from an outpatients palliative care service in Adelaide, Australia. Participants included patients (n = 13) with severe breathlessness associated with chronic obstructive pulmonary disease and their caregivers (n = 9). Results: Participants were interviewed at home. Eleven received morphine 8–32 mg. Three themes emerged: (1) independence; (2) breathlessness’ impact on driving; and (3) driving while taking regular, low-dose, sustained-release morphine. Conclusion: Driving contributed to a sense of identity and independence. Being able to drive increased the physical and social space available to patients and caregivers, their social engagement and well-being. Patients reported breathlessness at rest may impair driving skills, while the introduction of sustained-release morphine seemed to have no self-reported impact on driving. Investigating this last perception objectively, especially in terms of safety, is the subject of ongoing work.
Highlights
IntroductionChronic breathlessness persists and is disabling despite optimal treatment of the underlying disease(s). [1] Chronic breathlessness affects almost 10% of adults and 17% of those ≥65 years. [2] Patients with chronic obstructive pulmonary disease (COPD) are 13 affected, with >90% reporting breathlessness at some stage. [3] Chronic breathlessness is 15 physically and psychologically debilitating, [4] leading to increasing dependence, social isolation, and worse health-related and mortality outcomes. [5, 6] Loss of independence is profoundly distressing for caregivers, who struggle seeing their loved ones’ decline. [7, 8]Driving provides a sense of freedom, independence, identity and hope. [9] Not driving worsens social isolation and is associated with worse health-related outcomes. [10, 11] One quarter of people with life-limiting illnesses continue driving. [12] there is ample32 evidence that chronic breathlessness severely restricts people’s everyday lives, the effect of 34 chronic breathlessness on people’s driving ability has not been explored.Regular, low-dose (≤30mg/day), [13] sustained-release morphine safely reduces chronic breathlessness in people with COPD. [14, 15] Recently, low-dose, sustained-release morphine has been approved by regulatory bodies in Australia for the treatment of chronic breathlessness. [16] This is the first world approval of any medication for the symptomatic reduction of chronic breathlessness, likely increasing prescriptions for this indication.Simultaneously, there are concerns about safe driving while taking psychoactive substances, 51 including prescribed opioids. [17] While high dose opioids can impair driving, it is unknown53 whether regular, low dose, sustained-release morphine impacts on patients’ ability to drive, when initiating therapy and up-titration. [18]This aim of this qualitative study was to elicit patients’ and caregivers’ perceptions about http://mc.http://mc.manuscriptcentral.com/palliative-medicine driving with chronic breathlessness and to understand their perceptions about driving as regular, low dose, sustained release morphine was introduced
Low dose, sustained-release morphine safely reduces breathlessness, but little is known about its impact on driving
Chronic breathlessness is a debilitating syndrome, which can be ameliorated by 7 small doses of regular, low-dose, sustained-release morphine in some people
Summary
Chronic breathlessness persists and is disabling despite optimal treatment of the underlying disease(s). [1] Chronic breathlessness affects almost 10% of adults and 17% of those ≥65 years. [2] Patients with chronic obstructive pulmonary disease (COPD) are 13 affected, with >90% reporting breathlessness at some stage. [3] Chronic breathlessness is 15 physically and psychologically debilitating, [4] leading to increasing dependence, social isolation, and worse health-related and mortality outcomes. [5, 6] Loss of independence is profoundly distressing for caregivers, who struggle seeing their loved ones’ decline. [7, 8]Driving provides a sense of freedom, independence, identity and hope. [9] Not driving worsens social isolation and is associated with worse health-related outcomes. [10, 11] One quarter of people with life-limiting illnesses continue driving. [12] there is ample32 evidence that chronic breathlessness severely restricts people’s everyday lives, the effect of 34 chronic breathlessness on people’s driving ability has not been explored.Regular, low-dose (≤30mg/day), [13] sustained-release morphine safely reduces chronic breathlessness in people with COPD. [14, 15] Recently, low-dose, sustained-release morphine has been approved by regulatory bodies in Australia for the treatment of chronic breathlessness. [16] This is the first world approval of any medication for the symptomatic reduction of chronic breathlessness, likely increasing prescriptions for this indication.Simultaneously, there are concerns about safe driving while taking psychoactive substances, 51 including prescribed opioids. [17] While high dose opioids can impair driving, it is unknown53 whether regular, low dose, sustained-release morphine impacts on patients’ ability to drive, when initiating therapy and up-titration. [18]This aim of this qualitative study was to elicit patients’ and caregivers’ perceptions about http://mc.http://mc.manuscriptcentral.com/palliative-medicine driving with chronic breathlessness and to understand their perceptions about driving as regular, low dose, sustained release morphine was introduced. Low-dose (≤30mg/day), [13] sustained-release morphine safely reduces chronic breathlessness in people with COPD. 53 whether regular, low dose, sustained-release morphine impacts on patients’ ability to drive, when initiating therapy and up-titration. This aim of this qualitative study was to elicit patients’ and caregivers’ perceptions about http://mc.http://mc.manuscriptcentral.com/palliative-medicine driving with chronic breathlessness and to understand their perceptions about driving as regular, low dose, sustained release morphine was introduced. Low dose, sustained-release morphine safely reduces breathlessness, but little is known about its impact on driving
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