UICC World Cancer Congress 2006

Objective: Dyspnea has multiple causes; occurs among all ages and is prevalent in multiple disease entities. The American Thoracic Society 1999 consensus statement describes dyspnea as “a subjective experience of breathing discomfort, derived from interactions among multiple physiological, psychological, social, and environmental factors that may induce secondary physiological and behavioral responses.” The qualitative aspect of dyspnea has been examined less than other aspects of the symptom despite consensus that dyspnea is a subjective sensation. This review examines the qualitative research on dyspnea and proposes future research questions. Methods: A search of bibliographic computerized databases from 1990 until 2005 was conducted to yield nine English language citations that reported qualitative investigations of the patients' experience of dyspnea. Forchuk and Roberts' guideline was used to assess the rigor of the studies and extract the variables: research question, method, sample size and diagnosis, research setting, and findings. The studies were grouped according to methodology. Results: Findings demonstrate the subjective complexity of dyspnea. Three qualitative methods were found: phenomenology, triangulation and narrative ethnography. Three common themes surfaced from the nine studies: profound fear, loss of vitality and a need to legitimize dyspnea distress. Four helpful clinical actions synthesized from the studies include: 1) acknowledge the fear associated with the symptom. 2) model breathing synchronicity 3) provide presence, and 4) decrease external demands. This analysis demonstrates introductory acute dyspnea descriptors. Future qualitative studies to describe chronic dyspnea and caregivers' reactive experience to dyspnea are needed to increase knowing and bridge the gap towards quality care.