Total dyspnoea

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Abstract
To articulate a new conceptual model of breathlessness - termed total dyspnoea - which translates the well recognized total pain model to the realm of dyspnoea and addresses the patient's experiences of this symptom in the physical, psychological, social, and spiritual domains. In the past year, studies in the field of dyspnoea have explored a host of new approaches spanning pharmacological, mechanical, and behavioral strategies for symptom management and resolution. This flagship paper provides a unifying framework for considering these seemingly diverse approaches. The total dyspnoea model comprehensively defines the suffering of the individual experiencing dyspnoea, describing the patient's experience in a broad enough manner for the model to incorporate the wide spectrum of new treatment interventions. To avoid further fragmentation in clinical approaches to dyspnoea, healthcare providers need to view recent findings within the context of a coherent framework, one that places newly demonstrated interventions in the broader context of the full patient experience. This paper introduces total dyspnoea as a new paradigm that provides palliative care clinicians with an organizing structure for this complex symptom and body of evidence.

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