Slavica Kochovska, Diana Ferreira, Sungwon Chang, Tim Luckett, Jessica Roydhouse, Magnus Ekström, David C Currow
{"title":"常规、低剂量、缓释吗啡治疗慢性呼吸困难对护理者负担的影响:beam试验的探索性分析","authors":"Slavica Kochovska, Diana Ferreira, Sungwon Chang, Tim Luckett, Jessica Roydhouse, Magnus Ekström, David C Currow","doi":"10.1177/02692163231211227","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Chronic breathlessness adversely impacts people with chronic obstructive pulmonary disease and their caregivers (family and friends), who may, in turn, experience significant burden due to their caregiving role. Sustained-release morphine may reduce chronic breathlessness in some patients, which may have an impact on caregivers' perceived burden.</p><p><strong>Aim: </strong>To explore the impact on caregiver burden of active treatment of people with chronic breathlessness (modified Medical Research Council (mMRC) ⩾ 3) and chronic obstructive pulmonary disease (COPD) with regular, low-dose, sustained-release morphine within a multi-site, double-blind, randomised, placebo-controlled trial.</p><p><strong>Design: </strong>Exploratory analysis of self-reported caregiver burden at baseline and end of week 3 in a randomised, double-blind, placebo-controlled study. Caregiver measures included: demographics and perceived burden (Zarit Burden Interview 12-item short-form questionnaire). Patient measures included: <i>worst</i> breathlessness and FitBit<sup>R</sup>-measures.</p><p><strong>Setting/participants: </strong>All consenting caregivers of trial patient participants in a multi-site study recruiting from palliative care and respiratory services.</p><p><strong>Results: </strong>Caregivers (<i>n</i> = 49; 59% women; median age 68 years [IQR 50-75]) reported median baseline caregiver burden 12 [IQR 5-17], with 53% reporting high burden (⩾13). Eighty-four percent of caregivers reported no change in burden. In people whose <i>worst breathlessness</i> improved, caregiver burden moved in the same direction, though the correlation was not significant (<i>r<sub>s</sub></i> = 0.25, <i>p</i> = 0.17). Conversely, caregiver burden worsened as patients' <i>minutes lightly active</i> increased, with the correlation being significant (<i>r<sub>s</sub></i> = 0.56, <i>p</i> = 0.04).</p><p><strong>Conclusions: </strong>Caregivers reported high levels of caregiver burden, but patients' response to treatment in terms of their symptom and function may influence change in caregiver burden over a three-week period.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":null,"pages":null},"PeriodicalIF":3.6000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10798016/pdf/","citationCount":"0","resultStr":"{\"title\":\"The impact of regular, low-dose, sustained-release morphine for chronic breathlessness on caregiver burden: An exploratory analysis of the BEAMS trial.\",\"authors\":\"Slavica Kochovska, Diana Ferreira, Sungwon Chang, Tim Luckett, Jessica Roydhouse, Magnus Ekström, David C Currow\",\"doi\":\"10.1177/02692163231211227\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Chronic breathlessness adversely impacts people with chronic obstructive pulmonary disease and their caregivers (family and friends), who may, in turn, experience significant burden due to their caregiving role. Sustained-release morphine may reduce chronic breathlessness in some patients, which may have an impact on caregivers' perceived burden.</p><p><strong>Aim: </strong>To explore the impact on caregiver burden of active treatment of people with chronic breathlessness (modified Medical Research Council (mMRC) ⩾ 3) and chronic obstructive pulmonary disease (COPD) with regular, low-dose, sustained-release morphine within a multi-site, double-blind, randomised, placebo-controlled trial.</p><p><strong>Design: </strong>Exploratory analysis of self-reported caregiver burden at baseline and end of week 3 in a randomised, double-blind, placebo-controlled study. Caregiver measures included: demographics and perceived burden (Zarit Burden Interview 12-item short-form questionnaire). Patient measures included: <i>worst</i> breathlessness and FitBit<sup>R</sup>-measures.</p><p><strong>Setting/participants: </strong>All consenting caregivers of trial patient participants in a multi-site study recruiting from palliative care and respiratory services.</p><p><strong>Results: </strong>Caregivers (<i>n</i> = 49; 59% women; median age 68 years [IQR 50-75]) reported median baseline caregiver burden 12 [IQR 5-17], with 53% reporting high burden (⩾13). Eighty-four percent of caregivers reported no change in burden. In people whose <i>worst breathlessness</i> improved, caregiver burden moved in the same direction, though the correlation was not significant (<i>r<sub>s</sub></i> = 0.25, <i>p</i> = 0.17). Conversely, caregiver burden worsened as patients' <i>minutes lightly active</i> increased, with the correlation being significant (<i>r<sub>s</sub></i> = 0.56, <i>p</i> = 0.04).</p><p><strong>Conclusions: </strong>Caregivers reported high levels of caregiver burden, but patients' response to treatment in terms of their symptom and function may influence change in caregiver burden over a three-week period.</p>\",\"PeriodicalId\":19849,\"journal\":{\"name\":\"Palliative Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2024-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10798016/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Palliative Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/02692163231211227\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/11/17 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Palliative Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/02692163231211227","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/11/17 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
摘要
背景:慢性呼吸困难对慢性阻塞性肺疾病患者及其照护者(家人和朋友)产生不利影响,而照护者可能因其照护角色而承受重大负担。缓释吗啡可能减轻一些患者的慢性呼吸困难,这可能对护理人员的感知负担产生影响。目的:在一项多地点、双盲、随机、安慰剂对照试验中,探索慢性呼吸困难(改良医学研究委员会(mMRC)大于或等于3)和慢性阻塞性肺疾病(COPD)患者积极治疗对护理人员负担的影响,这些患者使用常规、低剂量、持续释放的吗啡。设计:在一项随机、双盲、安慰剂对照研究中,对基线和第3周末自我报告的照顾者负担进行探索性分析。护理人员测量包括:人口统计学和感知负担(Zarit负担访谈12项简短问卷)。患者测量包括:最严重呼吸困难和fitbitr测量。环境/参与者:在一项多地点研究中,从姑息治疗和呼吸服务部门招募试验患者参与者的所有同意的护理人员。结果:护理人员(n = 49;59%的女性;中位年龄68岁[IQR 50-75])报告了中位基线照顾者负担12 [IQR 5-17], 53%报告了高负担(小于或等于13)。84%的护理人员报告负担没有变化。在最严重的呼吸困难改善的患者中,护理人员的负担也朝着相同的方向移动,尽管相关性不显著(rs = 0.25, p = 0.17)。相反,随着患者轻度活动时间的增加,护理人员负担加重,相关性显著(rs = 0.56, p = 0.04)。结论:照顾者报告了高水平的照顾者负担,但患者在症状和功能方面对治疗的反应可能会影响三周内照顾者负担的变化。
The impact of regular, low-dose, sustained-release morphine for chronic breathlessness on caregiver burden: An exploratory analysis of the BEAMS trial.
Background: Chronic breathlessness adversely impacts people with chronic obstructive pulmonary disease and their caregivers (family and friends), who may, in turn, experience significant burden due to their caregiving role. Sustained-release morphine may reduce chronic breathlessness in some patients, which may have an impact on caregivers' perceived burden.
Aim: To explore the impact on caregiver burden of active treatment of people with chronic breathlessness (modified Medical Research Council (mMRC) ⩾ 3) and chronic obstructive pulmonary disease (COPD) with regular, low-dose, sustained-release morphine within a multi-site, double-blind, randomised, placebo-controlled trial.
Design: Exploratory analysis of self-reported caregiver burden at baseline and end of week 3 in a randomised, double-blind, placebo-controlled study. Caregiver measures included: demographics and perceived burden (Zarit Burden Interview 12-item short-form questionnaire). Patient measures included: worst breathlessness and FitBitR-measures.
Setting/participants: All consenting caregivers of trial patient participants in a multi-site study recruiting from palliative care and respiratory services.
Results: Caregivers (n = 49; 59% women; median age 68 years [IQR 50-75]) reported median baseline caregiver burden 12 [IQR 5-17], with 53% reporting high burden (⩾13). Eighty-four percent of caregivers reported no change in burden. In people whose worst breathlessness improved, caregiver burden moved in the same direction, though the correlation was not significant (rs = 0.25, p = 0.17). Conversely, caregiver burden worsened as patients' minutes lightly active increased, with the correlation being significant (rs = 0.56, p = 0.04).
Conclusions: Caregivers reported high levels of caregiver burden, but patients' response to treatment in terms of their symptom and function may influence change in caregiver burden over a three-week period.
期刊介绍:
Palliative Medicine is a highly ranked, peer reviewed scholarly journal dedicated to improving knowledge and clinical practice in the palliative care of patients with far advanced disease. This outstanding journal features editorials, original papers, review articles, case reports, correspondence and book reviews. Essential reading for all members of the palliative care team. This journal is a member of the Committee on Publication Ethics (COPE).