Hospitalist attitudes toward the assessment and management of dyspnea in patients with acute cardiopulmonary diseases

BACKGROUND: Dyspnea is a common symptom in patients hospitalized with acute cardiopulmonary diseases. Routine assessment of dyspnea severity is recommended by clinical guidelines based on the evidence that patients are not treated consistently for dyspnea relief. OBJECTIVE: To evaluate attitudes and beliefs of hospitalists regarding the assessment and management of dyspnea. DESIGN: Cross-sectional survey. SETTINGS: Nine hospitals in the United States. MEASUREMENTS: Survey questions assessed the following domains regarding dyspnea: importance in clinical care, potential benefits and challenges of implementing a standardized assessment, current approaches to assessment, and how awareness of severity affects management. A 5-point Likert scale was used to assess the respondent\u27s level of agreement; strongly agree and agree were combined into a single category. RESULTS: Of the 255 hospitalists invited to participate, 69.8% completed the survey; 77.0% agreed that dyspnea relief is an important goal when treating patients with cardiopulmonary conditions. Approximately 90% of respondents stated that awareness of dyspnea severity influences their decision to intensify treatment, to pursue additional diagnostic testing, and the timing of discharge. Of the respondents, 61.0% agreed that standardized assessment of dyspnea should be part of the vital signs, and 64.6% agreed that awareness of dyspnea severity influences their decision to prescribe opioids. Hospitalists who appreciated the importance of dyspnea in clinical practice were more likely to support the implementation of a standardized scale. CONCLUSIONS: Most hospitalists believe that routine assessment of dyspnea severity would enhance their clinical decision making and patient care. Measurement and documentation of dyspnea severity may represent an opportunity to improve dyspnea management