Clinical Practices Surrounding the Prescription of Home Oxygen in Patients with COPD and Desaturation.

Zaeh SE, Case M, Au DH, DaSilva M, Deitemeyer K, DeLisa J, Feemster LC, Gerald LB, Krishnan JA, Sculley J, Woodruff A, Eakin MN. Clinical Practices Surrounding the Prescription of Home Oxygen in Patients with COPD and Desaturation. Chronic obstructive pulmonary diseases (Miami, Fla.). 2023 Jul 11.

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Abstract:

PURPOSE: While home oxygen therapy increases survival in patients with chronic obstructive pulmonary disease (COPD) who have severe resting hypoxemia, recent evidence suggests that there is no survival benefit of home oxygen for patients with COPD who have isolated exertional desaturation. We aimed to understand clinician practice patterns surrounding the prescription of home oxygen for patients with COPD. METHODS: We conducted semi-structured qualitative interviews via videoconference with 18 physicians and nurse practitioners who provide care for patients with COPD. Clinicians were recruited through the American Lung Association Airways Clinical Research Centers. Interview guides were created with the assistance of patient investigators and included questions regarding clinician practices surrounding prescription of oxygen for patients with COPD and use of clinical guidelines. Interviews were recorded, transcribed, and coded for themes. RESULTS: Of the 18 clinician interviewees (15 physicians, 3 nurse practitioners), one-third were women, with most participants (n = 11) being < 50 years. Results of the semi-structured interviews suggested research evidence, clinical experience, and patient preferences contributed to clinician decision-making. Most clinicians described a shared decision-making process for prescribing home oxygen for patients including discussion of risks and benefits and developing an understanding of patient values and preferences. Clinicians did not use a structured tool to conduct these conversations. CONCLUSIONS: Clinicians consider a number of patient and clinical factors when prescribing home oxygen based, often using a shared decision-making process. Tools to support shared decision-making about the use of home oxygen are needed.