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Don’t ask, don’t tell (DADT) : under-recognition of breathlessness in clinical care—a national survey

Kochovska, Slavica ; Chang, Sungwon ; Ferreira, Diana ; Brunelli, Vanessa ; Luckett, Tim ; Morgan, Lucy ; Macdonald, Jessica ; Altree, Thomas ; Johnson, Miriam J. and Ekström, Magnus LU orcid , et al. (2025) In BMJ Open Respiratory Research 12(1).
Abstract

Introduction The recognition of breathlessness in clinical practice appears suboptimal, despite its prevalence and impact. This study aimed to explore the content of clinical conversations about breathlessness and patients’ level of self-reported openness when discussing their breathlessness. Methods A cross-sectional, online survey of Australian adults (≥18 years) stratified to the 2016 National Census for age, sex, state/territory of residence and rurality. Assessments based on self-report included demographics, breathlessness (modified Medical Research Council (mMRC) breathlessness scale), breathlessness duration (months/years) and underlying condition (multiple-choice question), breathlessness-related topics discussed... (More)

Introduction The recognition of breathlessness in clinical practice appears suboptimal, despite its prevalence and impact. This study aimed to explore the content of clinical conversations about breathlessness and patients’ level of self-reported openness when discussing their breathlessness. Methods A cross-sectional, online survey of Australian adults (≥18 years) stratified to the 2016 National Census for age, sex, state/territory of residence and rurality. Assessments based on self-report included demographics, breathlessness (modified Medical Research Council (mMRC) breathlessness scale), breathlessness duration (months/years) and underlying condition (multiple-choice question), breathlessness-related topics discussed (multiple-choice question) and patients’ openness about breathlessness (multiple-choice question). Results Of 4245 respondents with mMRC ≥1 2311 (54%) reported discussing breathlessness with their clinician. The majority were patient-initiated conversations (94%; n=2179) where the proportion discussing >1 topic was higher with each mMRC level (34% mMRC1; 40% mMRC2; 50% mMRC3-4) in contrast with clinician-initiated conversations (32% mMRC1; 5% mMRC2; 22% mMRC3-4). Patient-initiated conversations prioritised discussing the topics ‘how the person feels’ (mMRC1) and ‘breathlessness’ impacts’ (mMRC2-4); clinician-initiated consultations prioritised ‘breathlessness’ impacts’ (mMRC1-2) and ‘how the person feels’ and ‘doubts/fears’ (mMRC3-4). Compared with clinician-initiated conversations, patient-initiated ones had a higher proportion of respondents reporting being completely open (73% vs 56%, mMRC1; 58% vs 7%, mMRC2; 75% vs 22%, mMRC3-4). Increasing openness was associated with increasing age, gender (women), smoking status (non-smokers) and underlying condition (lung disease). Conclusions Many patients are willing to discuss multiple aspects of their breathlessness but may not disclose the full extent of the symptom’s presence or impacts.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Perception of Asthma/Breathlessness, Surveys and Questionnaires
in
BMJ Open Respiratory Research
volume
12
issue
1
article number
e003431
publisher
BMJ Publishing Group
external identifiers
  • scopus:105022232819
  • pmid:41253412
ISSN
2052-4439
DOI
10.1136/bmjresp-2025-003431
language
English
LU publication?
yes
additional info
Publisher Copyright: © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.
id
428762e3-e003-48e0-9303-6202c0ec03dc
date added to LUP
2026-01-22 10:22:32
date last changed
2026-01-23 11:18:55
@article{428762e3-e003-48e0-9303-6202c0ec03dc,
  abstract     = {{<p>Introduction The recognition of breathlessness in clinical practice appears suboptimal, despite its prevalence and impact. This study aimed to explore the content of clinical conversations about breathlessness and patients’ level of self-reported openness when discussing their breathlessness. Methods A cross-sectional, online survey of Australian adults (≥18 years) stratified to the 2016 National Census for age, sex, state/territory of residence and rurality. Assessments based on self-report included demographics, breathlessness (modified Medical Research Council (mMRC) breathlessness scale), breathlessness duration (months/years) and underlying condition (multiple-choice question), breathlessness-related topics discussed (multiple-choice question) and patients’ openness about breathlessness (multiple-choice question). Results Of 4245 respondents with mMRC ≥1 2311 (54%) reported discussing breathlessness with their clinician. The majority were patient-initiated conversations (94%; n=2179) where the proportion discussing &gt;1 topic was higher with each mMRC level (34% mMRC1; 40% mMRC2; 50% mMRC3-4) in contrast with clinician-initiated conversations (32% mMRC1; 5% mMRC2; 22% mMRC3-4). Patient-initiated conversations prioritised discussing the topics ‘how the person feels’ (mMRC1) and ‘breathlessness’ impacts’ (mMRC2-4); clinician-initiated consultations prioritised ‘breathlessness’ impacts’ (mMRC1-2) and ‘how the person feels’ and ‘doubts/fears’ (mMRC3-4). Compared with clinician-initiated conversations, patient-initiated ones had a higher proportion of respondents reporting being completely open (73% vs 56%, mMRC1; 58% vs 7%, mMRC2; 75% vs 22%, mMRC3-4). Increasing openness was associated with increasing age, gender (women), smoking status (non-smokers) and underlying condition (lung disease). Conclusions Many patients are willing to discuss multiple aspects of their breathlessness but may not disclose the full extent of the symptom’s presence or impacts.</p>}},
  author       = {{Kochovska, Slavica and Chang, Sungwon and Ferreira, Diana and Brunelli, Vanessa and Luckett, Tim and Morgan, Lucy and Macdonald, Jessica and Altree, Thomas and Johnson, Miriam J. and Ekström, Magnus and Currow, David}},
  issn         = {{2052-4439}},
  keywords     = {{Perception of Asthma/Breathlessness; Surveys and Questionnaires}},
  language     = {{eng}},
  month        = {{11}},
  number       = {{1}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{BMJ Open Respiratory Research}},
  title        = {{Don’t ask, don’t tell (DADT) : under-recognition of breathlessness in clinical care—a national survey}},
  url          = {{http://dx.doi.org/10.1136/bmjresp-2025-003431}},
  doi          = {{10.1136/bmjresp-2025-003431}},
  volume       = {{12}},
  year         = {{2025}},
}