Tracy A Smith1,2, Meera Agar3,4, Christine R Jenkins5,6, Jane M Ingham1,7, Patricia M Davidson8,9. 1. Faculty of Medicine, UNSW Australia, St Vincent's Clinical School, Sydney, New South Wales, Australia. 2. Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, New South Wales, Australia. 3. Palliative Care Unit, Braeside Hospital, Hammond Care, Sydney, New South Wales, Australia. 4. Discipline of Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia. 5. Department of Thoracic Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia. 6. Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia. 7. St Vincent's Health Network, Sydney, New South Wales, Australia. 8. School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA. 9. Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
Abstract
OBJECTIVE: Non-invasive ventilation (NIV) is widely used in the management of acute and acute-on-chronic respiratory failure. Understanding the experiences of patients treated with NIV is critical to person-centred care. We describe the subjective experiences of individuals treated with NIV for acute hypercapnic respiratory failure. DESIGN: Qualitative face-to-face interviews analysed using thematic analysis. SETTING: Australian tertiary teaching hospital. PARTICIPANTS: Individuals with acute hypercapnic respiratory failure treated with NIV outside the intensive care unit. Individuals who did not speak English or were unable or unwilling to consent were excluded. RESULTS: 13 participants were interviewed. Thematic saturation was achieved. Participants described NIV providing substantial relief from symptoms and causing discomfort. They described enduring NIV to facilitate another chance at life. Although participants sometimes appeared passive, others expressed a strong conviction that they knew which behaviours and treatments relieved their distress. Most participants described gaps in their recollection of acute hospitalisation and placed a great amount of trust in healthcare providers. All participants indicated that they would accept NIV in the future, if clinically indicated, and often expressed a sense of compulsion to accept NIV. Participants' description of their experience of NIV was intertwined with their experience of chronic disease. CONCLUSIONS: Participants described balancing the benefits and burdens of NIV, with the goal of achieving another chance at life. Gaps in recall of their treatment with NIV were frequent, potentially suggesting underlying delirium. The findings of this study inform patient-centred care, have implications for the care of patients requiring NIV and for advance care planning discussions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVE: Non-invasive ventilation (NIV) is widely used in the management of acute and acute-on-chronic respiratory failure. Understanding the experiences of patients treated with NIV is critical to person-centred care. We describe the subjective experiences of individuals treated with NIV for acute hypercapnic respiratory failure. DESIGN: Qualitative face-to-face interviews analysed using thematic analysis. SETTING: Australian tertiary teaching hospital. PARTICIPANTS: Individuals with acute hypercapnic respiratory failure treated with NIV outside the intensive care unit. Individuals who did not speak English or were unable or unwilling to consent were excluded. RESULTS: 13 participants were interviewed. Thematic saturation was achieved. Participants described NIV providing substantial relief from symptoms and causing discomfort. They described enduring NIV to facilitate another chance at life. Although participants sometimes appeared passive, others expressed a strong conviction that they knew which behaviours and treatments relieved their distress. Most participants described gaps in their recollection of acute hospitalisation and placed a great amount of trust in healthcare providers. All participants indicated that they would accept NIV in the future, if clinically indicated, and often expressed a sense of compulsion to accept NIV. Participants' description of their experience of NIV was intertwined with their experience of chronic disease. CONCLUSIONS:Participants described balancing the benefits and burdens of NIV, with the goal of achieving another chance at life. Gaps in recall of their treatment with NIV were frequent, potentially suggesting underlying delirium. The findings of this study inform patient-centred care, have implications for the care of patients requiring NIV and for advance care planning discussions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: Tim Luckett; Jane Phillips; Miriam Johnson; Maja Garcia; Priyanka Bhattarai; Virginia Carrieri-Kohlman; Anne Hutchinson; Rebecca T Disler; David Currow; Meera Agar; Serra Ivynian; Richard Chye; Phillip J Newton; Patricia M Davidson Journal: BMJ Open Date: 2017-12-06 Impact factor: 2.692