Developing A Breathlessness Intervention Service for Patients with Palliative and Supportive Care Needs, irrespective of Diagnosis

Booth, Sara; Moffat, Catherine; Farquhar, Morag; Higginson, Irene J; Burkin, Julie

doi:10.1177/082585971102700106

Cited by 48 publications

(36 citation statements)

References 16 publications

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“…A detailed study protocol [24] and detailed intervention description [16,17] are published elsewhere. Box 1 outlines the two-week intervention for advanced cancer (intervention duration determined by disease trajectory).…”

Section: Methodsmentioning

confidence: 99%

“…The Breathlessness Intervention Service (BIS) is a multi-disciplinary complex intervention combining non-pharmacological and pharmacological interventions to support breathless patients with advanced disease, theoretically underpinned by a palliative care approach [16-18]. Developed and evaluated [1,19-22] using the Medical Research Council (MRC) framework for complex interventions [23], it has undergone a Phase III RCT with two sub-protocols: one for advanced cancer and one for advanced non-malignant disease (differing service model for each) [24].…”

Section: Introductionmentioning

confidence: 99%

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Is a specialist breathlessness service more effective and cost-effective for patients with advanced cancer and their carers than standard care? Findings of a mixed-method randomised controlled trial

Farquhar

Prevost

McCrone

et al. 2014

BMC Med

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173

276

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BackgroundBreathlessness is common in advanced cancer. The Breathlessness Intervention Service (BIS) is a multi-disciplinary complex intervention theoretically underpinned by a palliative care approach, utilising evidence-based non-pharmacological and pharmacological interventions to support patients with advanced disease. We sought to establish whether BIS was more effective, and cost-effective, for patients with advanced cancer and their carers than standard care.MethodsA single-centre Phase III fast-track single-blind mixed-method randomised controlled trial (RCT) of BIS versus standard care was conducted. Participants were randomised to one of two groups (randomly permuted blocks). A total of 67 patients referred to BIS were randomised (intervention arm n = 35; control arm n = 32 received BIS after a two-week wait); 54 completed to the key outcome measurement. The primary outcome measure was a 0 to 10 numerical rating scale for patient distress due to breathlessness at two-weeks. Secondary outcomes were evaluated using the Chronic Respiratory Questionnaire, Hospital Anxiety and Depression Scale, Client Services Receipt Inventory, EQ-5D and topic-guided interviews.ResultsBIS reduced patient distress due to breathlessness (primary outcome: −1.29; 95% CI −2.57 to −0.005; P = 0.049) significantly more than the control group; 94% of respondents reported a positive impact (51/53). BIS reduced fear and worry, and increased confidence in managing breathlessness. Patients and carers consistently identified specific and repeatable aspects of the BIS model and interventions that helped. How interventions were delivered was important. BIS legitimised breathlessness and increased knowledge whilst making patients and carers feel ‘not alone’. BIS had a 66% likelihood of better outcomes in terms of reduced distress due to breathlessness at lower health/social care costs than standard care (81% with informal care costs included).ConclusionsBIS appears to be more effective and cost-effective in advanced cancer than standard care.Trial registrationRCT registration at ClinicalTrials.gov NCT00678405 (May 2008) and Current Controlled Trials ISRCTN04119516 (December 2008).Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0194-2) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is a specialist breathlessness service more effective and cost-effective for patients with advanced cancer and their carers than standard care? Findings of a mixed-method randomised controlled trial

Farquhar

Prevost

McCrone

et al. 2014

BMC Med

Self Cite

173

276

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“…The resulting pilot BIS aimed to help people live with breathlessness from any diagnostic cause (malignant or non-malignant), using a toolkit of pharmacological and non-pharmacological evidence-based interventions, by means of a flexible, multidisciplinary hospital palliative care outpatient service that functioned in the community (home visits). 35 At Phase I qualitative interviews were conducted with patients who had used the pilot service, their carers, referrers and service providers. These multipleperspective interviews focused on the experience of breathlessness, what was liked about the service, whether it worked, how it might work and what could be improved.…”

Section: Added Value Of Mixed Methods With Complex Interventions: Thementioning

confidence: 99%

Using mixed methods to develop and evaluate complex interventions in palliative care research

2011

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the development and evaluation of complex interventions in palliative care benefit from the application of mixed methods. Mixed methods enable better understanding of whether and how an intervention works (or does not work) and inform the design of subsequent studies. However, they can be challenging: mixed method studies in palliative care will benefit from working with agreed protocols, multidisciplinary teams and engaging staff with appropriate skill sets.

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“…When first assessing these patients with non-malignant disease it was evident that they were highly symptomatic and managing difficult psychosocial circumstances related to the impact of the illness and yet were not having these needs addressed 24 or being offered referral to palliative care services. Traditionally, palliative care services have seen patients only once they are gravely ill and facing death within a few months.…”

Section: Service Modelsmentioning

confidence: 98%

“…This breathlessness service has been described in detail elsewhere 24 and so a brief model of its functioning only is given here (see Box 2).…”

Section: Service Modelsmentioning

confidence: 99%

New models of care for advanced lung disease

Booth¹,

Bausewein

Rocker

2011

Progress in Palliative Care

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Developing A Breathlessness Intervention Service for Patients with Palliative and Supportive Care Needs, irrespective of Diagnosis

Cited by 48 publications

References 16 publications

Is a specialist breathlessness service more effective and cost-effective for patients with advanced cancer and their carers than standard care? Findings of a mixed-method randomised controlled trial

Is a specialist breathlessness service more effective and cost-effective for patients with advanced cancer and their carers than standard care? Findings of a mixed-method randomised controlled trial

Using mixed methods to develop and evaluate complex interventions in palliative care research

New models of care for advanced lung disease

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