Patients' and their caregivers' experiences with regular, low-dose, sustained-release morphine for chronic breathlessness associated with COPD: a qualitative study.

INTRODUCTION: Regular, low-dose, sustained-release morphine is effective in reducing chronic breathlessness in people with advanced disease, particularly in patients with chronic obstructive pulmonary disease (COPD). Despite experiencing a reduction in breathlessness, some patients choose not to continue long-term treatment. AIM: This study aimed to explore patients' and caregivers' experiences with regular, low-dose, sustained-release morphine for chronic breathlessness associated with COPD. METHODS: A qualitative study embedded in a randomised controlled trial (RCT) of regular low-dose, sustained-release morphine for chronic breathlessness for people with COPD and modified Medical Research Council breathlessness scale 3-4. After completing the RCT or withdrawing, patients and their caregivers were invited to participate in interviews in their homes focused on their experiences with the trial medication while still blinded to the arm to which they had been allocated. Data analysis used a constant comparative method informed by the principles of grounded theory. RESULTS: Thirteen patients and nine caregivers participated. Four themes were identified: (1) Receptivity and knowledge; (2) Function as a priority; (3) Harmful and helpful side effects; and (4) Therapy-centred aspects. The concept of 'net effect' emerged from the interplay between themes, subthemes and the decision to continue taking sustained-release morphine during the trial and after trial completion. CONCLUSION: Clinicians' support and preconceived ideas about morphine influence the decision to commence sustained-release morphine. The hope for functional improvement is the great driver influencing positively the decision to take sustained-release morphine in the long term. The degree of symptom reduction, improved function, side-effects' severity and caregivers' availability creates a net effect driving patients' decisions to continue or discontinue the medication.