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Assessing dyspnoea to make people more comfortable at the end of life

Study looks at improving end of life care through the use of a dyspnoea assessment tool

Study looks at improving end of life care through the use of a dyspnoea assessment tool

Dyspnoea – shortness of breath – is one of the most commonly occurring and distressing symptoms at the end of life, proving emotionally difficult and upsetting for patients, family members and professional carers alike.


Shortness of breath, known as dyspnoea, commonly occurs during end of life care
Picture: iStock

In the final days of life, many patients may lose or otherwise lack the physiological or cognitive capacity to self-report this symptom, placing greater onus on nurses to more capably assess breathing discomfort, so that it can be better treated and managed.

Structured educational programme

Conventionally, pragmatic empirical practice has been more common than the use of standardised assessment tools. This pre-experimental pre-test/post-test American study evaluated the impact of a structured educational programme for nurses, incorporating the introduction of an objective measure of respiratory distress into their practice.

The Respiratory Distress Observation Scale (RDOS) is a validated tool for the measurement of dyspnoea in patients who cannot self-report and was presented to 39 nurses in two settings: an inpatient unit and a rural community hospital in western US.

The nurses watched six brief simulation videos of clinical scenarios before their education about the tool and then watched them after being briefed about the RDOS tool. Participants completed assessment and treatment information after each video, and these were then evaluated to determine the ease of use of the RDOS tool and the benefits of the education received.

Results

The results suggest that there was no significant alteration in the nurse’s overall ability to appraise levels of patient comfort, or determine differential diagnoses, however there was an improvement in their ability to determine the level of dyspnoea and appropriate treatments. The tool was found to be easy to use and likely to be recommended for future clinical use.

Birkholz L, Haney T (2018) Using a dyspnea assessment tool to improve care at the end of life. Journal of Hospice and Palliative Nursing. 20, 3, 219-227.


Dion Smyth is lecturer in cancer and palliative care at Birmingham City University

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