Breathlessness during the last week of life in palliative care: An Australian prospective, longitudinal study

Ekström, Magnus, Allingham, Samuel F., Eagar, Kathy, Yates, Patsy, Johnson, Claire, & Currow, David C. (2016) Breathlessness during the last week of life in palliative care: An Australian prospective, longitudinal study. Journal of Pain and Symptom Management, 51(5), pp. 816-823.

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  • Breathlessness is a major cause of suffering and distress and little is known about the trajectory of breathlessness near death.


  • To determine the trajectory and clinical-demographical factors associated with breathlessness in the last week of life in specialist palliative care.


  • Prospective, longitudinal cohort study using national data in specialist palliative care from the Australian Palliative Care Outcomes Collaboration (PCOC). We included patients in PCOC who died between 1 July 2013 and 30 June 2014 with at least one measurement of breathlessness on a 0−10 numerical rating scale (NRS) in the week before death. The trajectory and factors associated with breathlessness were analyzed using multivariate random effects linear regression.


  • A total 12,778 patients from 87 services (33,404 data points) were analyzed. The average observed breathlessness was 2.1 points and remained constant over time. Thirty-five percent reported moderate to severe distress (NRS ≥ 4) at some time in their last week. Factors associated with higher breathlessness were younger age, male gender, cardiopulmonary involvement, concurrent fatigue, nausea, pain, sleeping problems, higher Australia-modified Karnofsky Performance Status, and clinical instability in the multivariate analysis. Respiratory failure showed the largest association (mean adjusted difference 3.1 points; 95% confidence interval, 2.8 to 3.4).


  • Although breathlessness has been reported to worsen in the last months, the mean severity remained stable in the final week of life. In specialized palliative care, one in three people experienced significant breathlessness especially in respiratory disease.

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ID Code: 96095
Item Type: Journal Article
Refereed: Yes
Keywords: Dyspnea; mortality; palliative care; terminal care; respiratory insufficiency; risk factors; cohort studies
DOI: 10.1016/j.jpainsymman.2015.12.311
ISSN: 0885-3924
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Nursing
Deposited On: 14 Jun 2016 22:51
Last Modified: 23 Jun 2016 05:48

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