Proper implementation of oxygen therapy within patients with interstitial lung disease (ILD) requires the strengthening of international guidelines, improved oxygen delivery systems, and equitable funding models.
Patients with interstitial lung disease (ILD) identified oxygen delivery system designs, little support, high costs, and inequitable access as barriers to oxygen therapy, according to a review published in the European Respiratory Review.
The researchers explained that oxygen therapy is often prescribed to patients with ILD to reduce shortness of breath, fatigue, and cough; they noted it can help patients increase physical capacity and improve survival. However, because of low-level evidence and expert opinion, oxygen therapy is difficult to prescribe, resulting in less successful results due to barriers concerning utilization and inequitable access.
They conducted a systemic review, synthesizing information from qualitative studies to identify the barriers to and facilitators of the use of oxygen therapy for people with an ILD, caregivers, and health care professionals. To find eligible studies, the researchers searched 5 databases using the terms “oxygen therapy,” “interstitial lung disease,” and “qualitative study design” up to November 2021 using extensive inclusion criteria.
After removing duplicates, the researchers then reviewed the full texts of the remaining studies. The Critical Appraisal Skills Program (CASP) tool was used to determine the quality of the studies; 2 researchers reviewed the quality independently before coming to a consensus on the final rating.
“Each criterion was scored as ‘1’ if the criterion was completely met; ‘0.5’ if the criterion was partially met; and ‘0’ if the criterion was not applicable, not met, or not mentioned,” the authors wrote. “Scores of 9-10 are defined as high quality, scores 7.5-9 as moderate quality, and <7.5 as low quality.”
The researchers identified 366 potential studies, but they ultimately used only 13 studies after conducting the review process. Of the included studies, 7 (54%) reported the perspective of people living with pulmonary fibrosis (PF)/ILD only, 2 (15%) reported the perspectives of caregivers only, 3 (23%) combined the views of patients with PF and caregivers, and 1 study was based on physicians’ perspectives.
Ultimately, the researchers found 9 studies were of high quality and 4 were of moderate quality. The studies analyzed the opinions of people from the United Kingdom, the United States, Australia, and Europe. Although these places all have different health care systems, the researchers noted the barriers identified were commonly reported.
Stakeholders across all studies asked for a more fit-to-purpose, portable oxygen delivery system that is lighter and easier to manage while still meeting oxygen requirements. The researchers explained that this is especially needed since many patients with ILD are frail, older, and have other comorbidities, making the oxygen delivery systems more difficult to handle.
Another universal complaint concerned the need for greater support for patients with ILD and their caregivers once oxygen is prescribed; this includes access to knowledge and information, ongoing support, and financial support. Participants expressed frustration with the lack of procedural information received before starting oxygen as they are often unaware of managing cylinders and associated costs. Also, some felt knowledge and ongoing support provided greater confidence to manage and persevere with oxygen.
Lastly, high costs and inequitable access were also common barriers to oxygen therapy. Costs forced many to not utilize it optimally, especially since insurance coverage within some countries was often limited. Additionally, inadequate service, lack of operational standards for suppliers, and billing inconsistencies caused patients anxiety about having an insufficient supply.
The researchers acknowledged several study limitations, one being that the included perspectives may not represent the views and experiences of all caregivers, physicians, and patients with ILD. It also lacked data from low- and middle-income countries, emphasizing longstanding unaddressed access inequities within these countries.
The researchers noted that future research should address gaps in evidence to provide international recommendations on when to prescribe, to whom, and its benefits. They added that providers should also work to resolve the identified problems surrounding oxygen therapy.
“There is an urgent need for innovation in oxygen delivery systems and sustainable equitable funding mechanisms to better meet the needs of user,” the authors concluded. “Increased information and support for user will be critical to optimize the uptake and outcomes of this important therapy.”
Tikellis G, Hoffman M, Mellerick C, Burge AT, Holland AE. Barriers to and facilitators of the use of oxygen therapy in people living with an interstitial lung disease: a systematic review of qualitative evidence. Eur Respir Rev. 2023;32(169):230066. doi:10.1183/16000617.0066-2023