Improving the management of breathlessness using a clinical effectiveness programme

Abstract

Breathlessness represents a significant problem for the person with advanced cancer. Uncontrolled breathlessness ranks highly in terms of uncomfortable symptoms experience, causing pain and distress to the patient and resulting in significant anxiety to their carers. The key to the provision of effective care lies in the informed application of the nursing process, underpinned by a sound knowledge base in relation to the nursing management of breathlessness. Theoretical knowledge enables nursing staff to offer appropriate interventions for the management of breathlessness in collaboration with other members of the multidisciplinary team. This article will discuss the cause and management of breathlessness in the person with advanced cancer; the discussion focuses on the application of research-based interventions and the evaluation of clinical outcomes in a UK clinical governance context.

Non-pharmacological interventions for breathlessness management in patients with lung cancer: a systematic review

“…Thirteen studies were excluded based on the selection criteria, and the results are listed in Table 1 with reasons for exclusion. 1,4,[6][7][8][9][10][11][12][13][14][15][16] Five studies met all the inclusion criteria for this review, and they are outlined in Table 2. [17][18][19][20][21] Assessment for the quality of the methodology of these studies was based on a standardised abstraction procedure.…”

“…Reason for exclusion Sola, et al 6 The two studies about breathless management were discussed in detail individually in this systematic review Jantarakupt and Porock 7 A descriptive review of the literature Rabow, et al 8 Study population did not confine to patients with lung cancer; there was no separate result analysis on patients with lung cancer either Kvale, et al 1 A descriptive study Dudgeon 9 A descriptive study Hoyal, et al 10 A descriptive study Thomas and von Gunten 11 A descriptive study Gallo-Silver and Pollack 12 A descriptive study Plant, et al 13 Outcomes did not meet the inclusion criteria LeGrand and Declan 14 A descriptive study Dudgeon and Rosenthal 4 A descriptive review of the literature Grey 15 A descriptive study Cowcher and Hanks 16 A descriptive study At 8 weeks, the intervention group showed significant improvement for breathlessness at best (P = 0.03), WHO performance status (P = 0.02), levels of depression (P = 0.02) and physical symptom distress (P = 0.04) A secondary analysis of three specific sub items on the activity level scale (R41: climb stairs; R43: walk outdoors; and R44: go shopping) showed significant improvement in activity levels for the intervention group (P = 0.05) Allocation concealment Adequate 1. Dyspnoea was reported less frequently at completion (P < 0.001) 2.…”