Atemnotattacken: Übersetzung und Konsentierung der internationalen Definition im Rahmen einer Delphi-Befragung

 

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Zusammenfassung

Hintergrund: Ähnlich wie Schmerzen kann refraktäre Atemnot intermittierend auftreten. Diese Atemnotattacken sind ein belastendes Symptom bei Patienten mit fortgeschrittenen, lebenslimitierenden Erkrankungen. Das Fehlen einer eindeutigen Definition behindert ein klares Symptomverständnis in der Praxis und eine effektive Therapie. Das Ziel der vorliegenden Studie war die Konsentierung der deutschen Übersetzung der englischsprachigen Definition, Kategorisierung und Terminologie von Atemnotattacken.

Methoden: Durchgeführt wurde eine webbasierte Delphi-Befragung mit deutschen Atemnotexperten (Arbeitsgruppe Atemnot der S3-Leitlinie Palliativmedizin). Entwürfe zur deutschsprachigen Definition und Terminologie wurden strukturiert binär („stimme zu, stimme nicht zu“) oder per Ranking bewertet. Optionale Freitextkommentare wurden inhaltsanalytisch ausgewertet. Konsens war definiert durch die Zustimmungsrate ≥ 70 %.

Ergebnisse: In zwei resultierenden Delphi-Runden nahmen 8/16 (50 %) und 11/16 (69 %) Experten teil (30–59 Jahre, 50 %/55 % weiblich). Nach der zweiten Befragungsrunde wurden die Symptombezeichnung „Atemnotattacke“ (73 %) und eine deutschsprachige Definition (90 %) konsentiert. Die Begriffe „vorhersehbar“ vs. „unvorhersehbar“ wurden nach der ersten Befragungsrunde für die Kategorisierung konsentiert (88 %).

Folgerung: Die formal konsentierte deutschsprachige Definition und Terminologie von Atemnotattacken ermöglichen ein klareres Symptomverständnis in Praxis und Lehre und eine präzise Erforschung des Symptoms und von Behandlungsoptionen in Deutschland. Effektive Präventions- und Behandlungsoptionen werden dringend benötigt, um die Lebensqualität belasteter Patienten und Angehöriger zu verbessern.

Abstract

Background: Similar to pain, refractory breathlessness can occur episodically. Episodic Breathlessness is a distressing symptom in patients with advanced life-limiting disease. The lack of a universal definition impedes symptom understanding in clinical practice and effective management, respectively. The aim of the study was to formally consent a German translation of the English definition and terminology of episodic breathlessness.

Methods: A web-based Delphi survey was conducted with German breathlessness experts (breathlessness working group of Germany‘s National Guideline (S3) for Palliative Care). Drafts of German-language definitions und terminology were assessed using structured questionnaires by binary rating or rankings, respectively. Optional comments were analysed by content analysis. Consensus was defined by ≥ 70 % agreement among participants.

Results: In two resulting Delphi-rounds 8/16 (50 %) und 11/16 (69 %) experts, 30–59 years of age, 50 %/55 % female, participated. After the second round, consensus was reached for the symptom’s description “Atemnotattacke” (73 %) and a German-language definition (90 %). The terms “vorhersehbar” vs. “unvorhersehbar” were directly consented for the categorization (88 %).

Conclusion: The formally consented German definition and terminology of episodic breathlessness enable clearer symptom understanding and provide a precise basis for education and research on the symptom and its management also in Germany. Effective management options are warranted to improve quality of life of suffering patients and their relatives.

• Literatur

• 1 Bausewein C, Simon ST. Shortness of Breath and Cough in Patients in Palliative Care. Dtsch Arztebl International 2013; 110: 563-572
  PubMedGoogle Scholar
• 2 Caraceni A, Davies A, Poulain P et al. Guidelines for the management of breakthrough pain in patients with cancer. J Natl Compr Canc Netw 2013; 11 (Suppl. 01) S29-36
  PubMedGoogle Scholar
• 3 Davies AN, Dickman A, Reid C et al. The management of cancer-related breakthrough pain: recommendations of a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland. Eur J Pain 2009; 13: 331-338
  CrossrefPubMedGoogle Scholar
• 4 Dorman S, Jolley C, Abernethy A et al. Researching breathlessness in palliative care: consensus statement of the National Cancer Research Institute Palliative Care Breathlessness Subgroup. Palliat Med 2009; 23: 213-227
  CrossrefPubMedGoogle Scholar
• 5 Fearon K, Strasser F, Anker SD et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 2011; 12: 489-495
  CrossrefPubMedGoogle Scholar
• 6 Ferguson ND, Davis AM, Slutsky AS et al. Development of a clinical definition for acute respiratory distress syndrome using the Delphi technique. J Crit Care 2005; 20: 147-154
  CrossrefPubMedGoogle Scholar
• 7 Freye E, Levy JV, Braun D. Effervescent morphine results in faster relief of breakthrough pain in patients compared to immediate release morphine sulfate tablet. Pain Pract 2007; 7: 324-331
  CrossrefPubMedGoogle Scholar
• 8 Häder M. Delphi-Befragungen: Ein Arbeitsbuch. 2.. Auflage. Wiesbaden: VS Verlag für Sozialwissenschaften; 2009
  CrossrefGoogle Scholar
• 9 Hui D, Xu A, Frisbee-Hume S et al. Effects of prophylactic subcutaneous fentanyl on exercise-induced breakthrough dyspnea in cancer patients: a preliminary double-blind, randomized, controlled trial. J Pain Symptom Manage 2014; 47: 209-217
  CrossrefPubMedGoogle Scholar
• 10 Johnson TP, Wislar JS. Response rates and nonresponse errors in surveys. JAMA 2012; 307: 1805-1806
  CrossrefPubMedGoogle Scholar
• 11 Lai YL, Chan CW, Lopez V. Perceptions of dyspnea and helpful interventions during the advanced stage of lung cancer: Chinese patients’ perspectives. Cancer Nurs 2007; 30: E1-8
  PubMedGoogle Scholar
• 12 Maddocks M, Taylor V, Klezlova R et al. When will I get my breath back? Recovery time of exercise-induced breathlessness in patients with thoracic cancer. Lung Cancer 2012; 76: 128-129
  CrossrefPubMedGoogle Scholar
• 13 Murphy MK, Black NA, Lamping DL et al. Consensus development methods, and their use in clinical guideline development. Health Technol Assess 1998; 2: i-iv, 1-88
  PubMedGoogle Scholar
• 14 O'Driscoll M, Corner J, Bailey C. The experience of breathlessness in lung cancer. Eur J Cancer Care (Engl) 1999; 8: 37-43
  CrossrefPubMedGoogle Scholar
• 15 Reddy SK, Parsons HA, Elsayem A et al. Characteristics and correlates of dyspnea in patients with advanced cancer. J Palliat Med 2009; 12: 29-36
  CrossrefPubMedGoogle Scholar
• 16 Rueda JR, Sola I, Pascual A et al. Non-invasive interventions for improving well-being and quality of life in patients with lung cancer. Cochrane Database Syst Rev 2011; CD004282
  PubMedGoogle Scholar
• 17 Simon ST, Bausewein C, Schildmann E et al. Episodic breathlessness in patients with advanced disease: a systematic review. J Pain Symptom Manage 2013; 45: 561-578
  CrossrefPubMedGoogle Scholar
• 18 Simon ST, Koskeroglu P, Gaertner J et al. Fentanyl for the relief of refractory breathlessness: a systematic review. J Pain Symptom Manage 2013; 46: 874-886
  CrossrefPubMedGoogle Scholar
• 19 Simon ST, Weingärtner V, Higginson IJ et al. Definition, Categorization, and Terminology of Episodic Breathlessness: Consensus by an International Delphi Survey. J Pain Symptom Manage 2014; 47: 828-838
  CrossrefPubMedGoogle Scholar
• 20 Smith BH, Torrance N, Ferguson JA et al. Towards a definition of refractory neuropathic pain for epidemiological research. An international Delphi survey of experts. BMC Neurol 2012; 12: 29
  CrossrefPubMedGoogle Scholar
• 21 Weingärtner V, Bausewein C, Higginson IJ et al. Characterizing episodic breathlessness in patients with advanced disease. J Palliat Med 2013; 16: 1275-1279
  CrossrefPubMedGoogle Scholar