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Understanding Dyspnea: Psychological Impact on Patients, Families & Health Care Providers

This article explores the psychological impact of dyspnea on patients, families, and healthcare providers, discussing its similarities to pain perception, the importance of addressing dyspnea in holistic care plans, and the neurophysiological aspects of emotional responses. It also delves into the fear, anxiety, and distress experienced by patients and families, emphasizing the need for comprehensive approaches beyond medication and oxygen therapy. The role of healthcare providers in managing dyspnea and supporting patients and families is highlighted.

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Understanding Dyspnea: Psychological Impact on Patients, Families & Health Care Providers

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  1. Dyspnea: Psychological Impact on Patients & Families & Health Care Providers Larry Librach MD,CCFP,FCFP Professor, Dept. of Family & Community Medicine Sun Life Financial Chair in Bioethics & Director Joint Centre for Bioethics, University of Toronto QI Lead , TemmyLatner Centre for Palliative Care

  2. Importance • Perception of dyspnea is considered analogous to the perception of pain & consists of sensory (intensity) & affective (unpleasantness) dimensions • Similar cortical processes appear to underlie experience of dyspnea & pain

  3. Importance • Both symptoms result in added suffering • Anxiety, depression, & other psychological factors occur frequently in patients with advanced disease & influence breathlessness • Distressing symptom that requires attention, consideration, & treatment by healthcare providers

  4. Importance • HCPs are ethically obligated to treat dyspnea, & patients & their families should be reassured that they will be provided the means to effectively treat this symptom • Approach to care should be reflected in goals of care & care plan that involves a holistic approach

  5. Goals of Care for Dyspnea • Because patients do not experience dyspnea in isolation but rather in conjunction with other symptoms, concomitant stressors, & spiritual or existential distress • Dyspnea cannot be fully addressed unless these physical & nonphysical factors are understood.

  6. Psychological Impact

  7. Psychological Impact-Patient FEAR ! • Of suffocation • Added suffering • Added burden for family • Need for hastened death

  8. Neurophysiology • Anterior cingulate gyrus on cortex is area of brain that is responsible for emotional impact of physical symptoms like pain & dyspnea • Linked to thalamus by opioid sensitive pathway

  9. Psychological Impact-Patient • Manifestations include: • Anxiety • Panic • Poor sleep • Depression

  10. Psychological Impact-Patient • Opioids appropriate • Approach requires more than medication • Oxygen is not a panacea and may actually increase anxiety • Counselling important • Reassuring conversations & education • Outline expectations • Discuss continuing evaluation

  11. Psychological Impact-Family • Again fear of suffocation & witnessing an agonizing death • Sense of helplessness • Anxiety about the very end of life & whether hospital the best place

  12. Psychological Impact-Family • Approach requires regular visits, reassurance re: accessibility • Also reassurance re: role of oxygen as it is not a panacea

  13. Psychological ImpactHealth Care Providers • Sense of “need to do something” • Anxiety around need for oxygen • Foreboding about suffocation • Anxiety around when to institute sedation

  14. Summary • Dyspnea is a common symptom in palliative care • Induces great fear • Success is most likely when as many as possible of the patient’s individual dyspnea stressors & concomitant symptoms (i.e., anxiety, depression, panic attacks) are identified & addressed

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