Progredienzangst und End-of-Life-Ängste bei COPD-Patienten

Zusammenfassung

Zahlreiche Studien zeigen eine hohe Komorbidität der COPD mit psychischen Beschwerden. Angesichts der realen Bedrohung durch die Erkrankung treten bei den Betroffenen auch krankheitsbezogene Ängste (Progredienz, End-of-Life) auf. Diese können die Lebensqualität beeinträchtigen und den Krankheitsverlauf verschlechtern. Es existieren wenige Studien, die krankheitsbezogene Ängste bei COPD untersuchen. Ziel der Studie war es, Zusammenhänge zwischen krankheitsbezogenen Ängsten, psychischer Symptomatik und Lebensqualität zu erfassen sowie deskriptive Erkenntnisse zu krankheitsbezogenen Ängsten und End-of-Life-Care zu berichten. An der Untersuchung nahmen 132 COPD-Patienten teil. Es zeigten sich keine Unterschiede im Ausmaß der krankheitsbezogenen Ängste zwischen verschiedenen COPD-Stadien. Es ergaben sich signifikante Korrelationen der End-of-Life-Ängste zu Progredienzangst, Depressivität und psychischer Lebensqualität. Deskriptive Analysen zeigten, dass bezüglich der Kommunikation von End-of-Life-Aspekten erheblicher Verbesserungsbedarf besteht. Unsere Ergebnisse unterstreichen die große Bedeutung krankheitsbezogener und End-of-Life-Ängste bei COPD.

Abstract

Anxiety and depression are prevalent comorbid conditions in COPD. Furthermore, diseases related anxieties (fear of progression, end-of-life fear) occur very often. Anxiety can have a negative impact on patients’ quality of life and is sometimes even considered as a risk factor for re-hospitalisation. There are only a few studies that focus on disease related anxieties in COPD. The aim of our study was to investigate the associations between disease related anxieties (fear of progression, end-of-life fear), psychological health status and quality of life in COPD patients. 132 patients with COPD (GOLD II-IV) participated in the study. Results of a MANOVA showed no differences between diseases related anxieties among patients with different disease severity (GOLD II-IV). Furthermore, the results showed significant associations between end-of-life fear, fear of progression, depression and quality of life. Further analyses showed that there is a need for managing end-of-life fears and improving end-of-life care. Overall, our study showed, that health disease related anxieties play an important role in COPD and still do not receive enough attention.

• Literatur

• 1 Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of COPD. Updated 2007 http://www.goldcopd.org
• 2 Kunik ME, Veazey C, Cully JA et al. COPD education and cognitive behavioral therapy group treatment for clinically significant symptoms of depression and anxiety in COPD patients: A randomized controlled trial. Psychol Med 2008; 38: 385-396
• 3 Putman-Casdorph H, McCrone S. Chronic obstructive pulmonary disease, anxiety, and depression: state of the science. Heart Lung 2009; 38: 34-47
• 4 Yohannes AM, Baldwin RC, Connolly MJ. Mood disorders in elderly patients with chronic obstructive pulmonary disease. Rev Clin Gerontol 2000; 10: 193-202
• 5 Kunik ME, Braun U, Stanley MA et al. One session cognitive behavioural therapy for elderly patients with chronic obstructive pulmonary disease. Psychol Med 2001; 31: 717-723
• 6 Vogelmeier C, Buhl R, Criée CP et al. Leitlinie der deutschen Atemwegsliga und der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD). Pneumologie 2007; 61: 1-40
• 7 Kunik ME, Roundy K, Veazey C et al. Surprisingly high prevalence of anxiety and depression in chronic breathing disorders. Chest 2005; 127: 1205-1211
• 8 Hynninen KMJ, Breitve MH, Wiborg AB et al. Psychological characteristics of patients with chronic obstructive pulmonary disease: A review. J Psychosom Res 2005; 59: 429-443
• 9 Hill K, Geist R, Goldstein RS et al. Anxiety and depression in end-stage COPD. Eur Respir J 2008; 31: 667-677
• 10 Solano JP, Gomes B, Higginson IJ. A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manage 2006; 31: 58-69
• 11 Kühl K, Kenn K, Kuhn C et al. Der COPD-Angst-Fragebogen (CAF): Ein neues Instrument zur Erfassung krankheitsspezifischer Ängste bei Patienten mit COPD. Psychother Psych Med 2011; 61: 25-31
• 12 Gore JM, Brophy CJ, Greenstone MA. How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer. . Thorax 2000; 55: 1000-1006
• 13 Habraken JM, ter Riet G, Gore JM et al. Health-related quality of life in end-stage COPD and lung cancer patients. J Pain Symptom Manage 2009; 37: 973-981
• 14 Sutton K, Cooper MJ, Pimm J et al. Anxiety in chronic obstructive pulmonary disease: The role of illness specific catastrophic thoughts. Cognit Ther Res 1999; 23: 573-585
• 15 Dankert A, Duran G, Engst-Hastreiter U et al. Progredienzangst bei Patienten mit Tumorerkrankungen, Diabetes mellitus und entzündlich-rheumatischen Erkrankungen. Rehabilitation 2003; 42: 155-163
• 16 Claessens MT, Lynn S, Zhong Z et al. Dying with lung cancer or chronic obstructive pulmonary disease: insights from SUPPORT. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. J Am Geriatr Soc 2000; 48: 146-153
• 17 Curtis JR, Engelberg RA, Nielsen EL et al. Patient-physician communication about end-of-life care for patients with severe COPD. Eur Respir J 2004; 24: 200-205
• 18 Rocker GM, Dodek PM, Hyland DK. Toward optimal end-of-life care for patients with advanced chronic obstructive pulmonary disease: insights from a multicentre study. Can Respir J 2008; 15: 249-254
• 19 Kinnunen T, Säynäjäkangas O, Keistinen T. Features of hospitalisations for acute exacerbation of COPD resulting in death. Monaldi Arch Chest Dis 2007; 67: 10-14
• 20 Zigmond AS, Snaith RP. The Hospital Anxiety And Depression Scale. Acta Psychiatr Scand 1983; 67: 361-370
• 21 Hütter BO. SGRQ - St. Georges Respiratory Questionnaire. In: Schumacher J, Klaiberg A, Brähler E, eds. Diagnostische Verfahren zu Lebensqualität und Wohlbefinden. Göttingen: Hogrefe; 2003: 280-285
• 22 Jones PW, Quirk FH, Baveystock CM. The St George’s Respiratory Questionnaire. Respir Med 1991; 85: 25-31
• 23 Wittkowski J. Fragebogeninventar zur mehrdimensionalen Erfassung des Erlebens gegenüber Sterben und Tod – FIMEST. Göttingen: Hogrefe; 1996
• 24 Ochmann R. Angst vor Tod und Sterben. Göttingen: Hogrefe; 1993
• 25 Curtis JR, Engelberg RA, Wenrich MD et al. Communication about palliative care for patients with chronic obstructive pulmonary disease. J Palliat Care 2005; 21: 157-164
• 26 Curtis JR, Patrick DL. The assessment of health status among patients with COPD. Eur Respir J 2003; 21: 36-45
• 27 Curtis JR, Wenrich MD, Carline JD et al. Patients’ perspectives on physician skill in end-of-life care: Differences between patients with COPD, cancer, and AIDS. Chest 2002; 122: 356-362
• 28 Hien P, Morr H. 6-Minuten-Gehtest in der pneumologischen und kardiologischen Diagnostik. Pneumologie 2002; 56: 558-566
• 29 Kühl K, Schürmann W, Rief W. COPD-Disability-Index (CDI) – ein neues Verfahren zur Erfassung der COPD-bedingten Beeinträchtigung. Pneumologie 2009; 63: 136-143
• 30 Kühl K, Schürmann W, Rief W. Mental disorders and quality of life in COPD patients and their spouses. Int J Chron Obstruct Pulmon Dis 2008; 3: 727-736
• 31 Miravitlles M, Molina J, Naberan K et al. Factors determining the quality of life of patients with COPD in primary care. Ther Adv Respir Dis 2007; 1: 85-92
• 32 Aydin IO, Ulusahin A. Depression, anxiety comorbidity, and disability in tuberculosis and chronic obstructive pulmonary disease patients: Applicability of GHQ-12. Gen Hosp Psychiatry 2001; 23: 77-83
• 33 Gudmundsson G, Gislason T, Janson C et al. Depression, anxiety and health status after hospitalisation for COPD: a multicentre study in the Nordic countries. Respir Med 2006; 100: 87-93
• 34 Herschbach P, Berg P, Waadt S et al. Group psychotherapy of dysfunctional fear of progression in patients with chronic arthritis and cancer. Psychother Psychosom 2010; 79: 31-38
• 35 Gardiner C, Gott M, Small N et al. Living with advanced chronic obstructive pulmonary disease: patients concerns regarding death and dying. Palliat Med 2009; 23: 691-697
• 36 Knauft E, Nielsen EL, Engelberg RA et al. Barriers and facilitators to end-of-life care communication for patients with COPD. Chest 2005; 127: 2188-2196
• 37 Spathis A, Booth S. End of life care in chronic obstructive pulmonary disease: in search of a good death. Int J Chron Obstruct Pulmon Dis 2008; 3: 11-29
• 38 Engst-Hastreiter U, Duran G, Henrich G et al. Progredienzangst (PA) bei chronischen Erkrankungen (Rheumatischen Erkrankungen, Krebserkrankungen und Diabetes mellitus). Akt Rheumatol 2004; 29: 83-91