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      Patients’ and caregivers’ experiences of driving with chronic breathlessness before and after regular low-dose sustained-release morphine: A qualitative study

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          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.

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          Most cited references41

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          Explanatory and pragmatic attitudes in therapeutical trials

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            Physician-patient-companion communication and decision-making: a systematic review of triadic medical consultations.

            To systematically review quantitative and qualitative studies exploring physician-adult patient-adult companion (triadic) communication and/or decision-making within all medical encounters. Studies were identified via database searches and reference lists. One author assessed eligibility of studies, verified by two co-authors. Data were extracted by one author and cross-checked for accuracy. Two authors assessed the quality of included articles using standardized criteria. Of the 8409 titles identified, 52 studies were included. Summary statements and tables were developed for each of five identified themes. Results indicated companions regularly attended consultations, were frequently perceived as helpful, and assumed a variety of roles. However, their involvement often raised challenges. Patients with increased need were more often accompanied. Some companion behaviours were felt to be more helpful (e.g. informational support) and less helpful (e.g. dominating/demanding behaviours), and preferences for involvement varied widely. Triadic communication in medical encounters can be helpful but challenging. Based on analysis of included studies, preliminary strategies for health professionals are proposed. Preliminary strategies for health professionals include (i) encourage/involve companions, (ii) highlight helpful companion behaviours, (iii) clarify and agree upon role preferences of patient/companions. Future studies should develop and evaluate specific strategies for optimizing triadic consultations. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
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              The “core category” of grounded theory: Making constant comparisons

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                Author and article information

                Contributors
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                Journal
                Palliative Medicine
                Palliat Med
                SAGE Publications
                0269-2163
                1477-030X
                September 2020
                June 10 2020
                September 2020
                : 34
                : 8
                : 1078-1087
                Affiliations
                [1 ]Palliative and Supportive Services, Flinders University, Bedford Park, SA, Australia
                [2 ]Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
                [3 ]IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
                Article
                10.1177/0269216320929549
                32519599
                9114fbdf-a1e0-408e-b53b-20bd1cf47dad
                © 2020

                http://journals.sagepub.com/page/policies/text-and-data-mining-license

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