Holistic services for people with advanced disease and chronic breathlessness: a systematic review and meta-analysis

Abstract

BackgroundBreathlessness is a common, distressing symptom in people with advanced disease and a marker of deterioration. Holistic services that draw on integrated palliative care have been developed for this group. This systematic review aimed to examine the outcomes, experiences and therapeutic components of these services.MethodsSystematic review searching nine databases to June 2017 for experimental, qualitative and observational studies. Eligibility and quality were independently assessed by two authors. Data on service models, health and cost outcomes were synthesised, using meta-analyses as indicated. Data on recipient experiences were synthesised thematically and integrated at the level of interpretation and reporting.ResultsFrom 3239 records identified, 37 articles were included representing 18 different services. Most services enrolled people with thoracic cancer, involved palliative care staff and comprised 4–6 contacts over 4–6 weeks. Commonly used interventions included breathing techniques, psychological support and relaxation techniques. Meta-analyses demonstrated reductions in Numeric Rating Scale distress due to breathlessness (n=324; mean difference (MD) −2.30, 95% CI −4.43 to −0.16, p=0.03) and Hospital Anxiety and Depression Scale (HADS) depression scores (n=408, MD −1.67, 95% CI −2.52 to −0.81, p<0.001) favouring the intervention. Statistically non-significant effects were observed for Chronic Respiratory Questionnaire (CRQ) mastery (n=259, MD 0.23, 95% CI −0.10 to 0.55, p=0.17) and HADS anxiety scores (n=552, MD −1.59, 95% CI −3.22 to 0.05, p=0.06). Patients and carers valued tailored education, self-management interventions and expert staff providing person-centred, dignified care. However, there was no observable effect on health status or quality of life, and mixed evidence around physical function.ConclusionHolistic services for chronic breathlessness can reduce distress in patients with advanced disease and may improve psychological outcomes of anxiety and depression. Therapeutic components of these services should be shared and integrated into clinical practice.Registration numberCRD42017057508.

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

“…Our findings resonate with ideas around needing more tailored interventions for people with frailty 76 and respiratory disease, 77 thinking creatively about engagement with exercise-based interventions, 78 and taking integrated approaches to support the maintenance of physical and mental capacities in an aging population. 79 Recent examples within wider respiratory care include interdisciplinary models of primary care for people with COPD, 80 integrated respiratory and palliative care services for chronic breathlessness, 81 and rehabilitation for people with both respiratory and heart disease. 82 As research specifically with people with COPD and frailty increases, 50,54 this type of complex interventional work will be a priority.…”

Holistic services for people with advanced disease and chronic or refractory breathlessness: a mixed-methods evidence synthesis

“…We have shared findings via open-access publications in scientific journals. 92,171,172 Plain English summaries have been completed for each study component. 182,183 This project has been presented at several meetings to varied audiences (see List 1: presentations) and additional abstracts have been submitted [e.g.…”

“…Barton et al 99 Bredin et al 98 Corner et al 90 Farquhar et al 91 Farquhar et al 95 Higginson et al 94 Johnson 92 This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.…”

“…Individual studies have reported positive outcomes from these services for patients and carers including higher levels of patient satisfaction, improved self-reported breathlessness mastery, and reduced patient distress, health-care contacts and need for informal care, without increasing the overall cost to the UK NHS. [89][90][91][92][93][94][95] One study also suggested a potential survival advantage. 94 Alongside this, international guidelines have advocated early integration of palliative care for people experiencing chronic disease, 96,97 for which chronic and/or distressing breathlessness could be a suitable indicator for referral (particularly in non-cancer conditions in which prognostication causes delays 54 ).…”

“…df, degrees of freedom; IV, inverse variable. Reproduced with permission from Brighton et al92 This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for or any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/ licenses/by/4.0/.Bredin et al 199998 Corner et al 199690 Farquhar et al 201491 Farquhar et al 201695 Higginson et al 201494 Yorke et al 2015157…”