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

Ferreira, Diana H; Boland, Jason W.; Kochovska, Slavica; Honson, Aaron; Phillips, Jane L; Currow, David C.

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.

Citation

Ferreira, D. H., Boland, J. W., Kochovska, S., Honson, A., Phillips, J. L., & Currow, D. C. (2020). Patients’ and caregivers’ experiences of driving with chronic breathlessness before and after regular low-dose sustained-release morphine: A qualitative study. Palliative medicine, 34(8), 1078-1087. https://doi.org/10.1177/0269216320929549

• Journal Article Type: Article
• Acceptance Date: May 4, 2020
• Online Publication Date: Jun 10, 2020
• Publication Date: Sep 1, 2020
• Deposit Date: Jun 15, 2020
• Publicly Available Date: Jun 16, 2020
• Journal: Palliative Medicine
• Print ISSN: 0269-2163
• Electronic ISSN: 1477-030X
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 34
• Issue: 8
• Pages: 1078-1087
• DOI: https://doi.org/10.1177/0269216320929549
• Keywords: Driving; Opioids; Morphine; Breathlessness; Dyspnoea; Caregivers; Patients
• Public URL: https://hull-repository.worktribe.com/output/3520923
• Publisher URL: https://journals.sagepub.com/doi/10.1177/0269216320929549