Non-medical devices for chronic breathlessness: use, barriers and facilitators for patients, carers and clinicians - a scoping review

Prihartadi, Aliya; Licastro, Giovanna Impelliziere; Pearson, Mark; Johnson, Miriam J.; Luckett, Tim; Swan, Flavia

doi:10.1136/bmjspcare-2021-002962

Cited by 6 publications

(6 citation statements)

References 54 publications

(168 reference statements)

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“…However, it seems that current delivery strategies may not always be effective. Our finding that patients believe that a fan is too simple to be credible is consistent with a mixedmethods feasibility RCT [24] where such patient beliefs was a key concern for clinicians implementing the fan influencing uptake and long-term use [27].…”

Section: Plos Onesupporting

confidence: 82%

“…This was a qualitative in-depth semi-structured interview study. Ethical approval for the study was granted by HYMS Faculty Ethics Committee, University of Hull July 2020 (REF [20][21][22][23][24][25][26][27][28]. The study is reported in accordance with the Consolidated criteria for Reporting Qualitative studies (COREQ) [31].…”

Section: Methodsmentioning

confidence: 99%

“…These findings emphasize the importance of the way the fan is implemented with patients [ 26 ] but little is known about how clinicians’ implement the fan in clinical practice. A scoping review explored patient, carer and clinician implementation of non-medical aids for chronic breathlessness management found no studies focussing on implementation from the clinicians’ viewpoint [ 27 ]. Since then, one study of Australian specialist respiratory clinicians’ fan use with COPD patients has been published [ 28 ].…”

Section: Introductionmentioning

confidence: 99%

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The handheld fan for chronic breathlessness: Clinicians’ experiences and views of implementation in clinical practice

Brown,

Miller,

Barnes-Harris

et al. 2023

PLoS ONE

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Introduction The handheld fan (‘fan’) is useful for chronic breathlessness management, however little is known about clinicians’ implementation of the fan in clinical practice. Aim To explore clinicians’ experiences and views of fan implementation. Methods A qualitative approach, using semi-structured interviews. Participants were purposively sampled from clinicians who had completed an on-line fan implementation survey and were willing to participate. A topic guide was developed using the Theoretical Domains Framework (TDF). Data were analysed using an inductive approach informed by the TDF. Findings Twelve clinicians participated (doctors n = 4; nurses n = 4; allied health professionals n = 4) from respiratory and palliative care. Analysis generated three major themes: i) Clinician knowledge and skills in fan implementation, ii) environmental constraints on fan use and iii) clinician beliefs about the consequences of fan use. Implementation by clinicians was positively influenced by having a scientific rationale for fan use presented (mechanism of action). Clinicians believed that the fan relieved breathlessness and did not carry a significant infection risk. Opportunity for fan use varied across healthcare settings; key environmental influences were COVID-19 restrictions, lack of access to resources and funding to provide fans, particularly in acute and respiratory services. Clinicians commonly encountered scepticism among patients and colleagues who felt the fan was an implausible intervention for breathlessness. Conclusion Implementation of the fan is motivated by clinician beliefs about patient-benefit, a scientific rationale to counter clinician and patient scepticism, and access to fans in clinic. Funding to allow patients to be supplied with and taught how to use a fan would support uptake. Research is needed to address concerns about infection risk.

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Section: Plos Onesupporting

confidence: 82%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The handheld fan for chronic breathlessness: Clinicians’ experiences and views of implementation in clinical practice

Brown,

Miller,

Barnes-Harris

et al. 2023

PLoS ONE

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“…Non-pharmacologic strategies, the foundation of breathlessness management, 31 are increasingly highlighted in the ILD literature. 32 , 33 A qualitative study of 13 IPF patients described a patient-reported benefit from symptom self-management education, with 80% reporting self-efficacy in symptom management. 26 Nonetheless, they are rarely prescribed in F-ILD in practice.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective, Descriptive Study of Dyspnea Management in a Multidisciplinary Interstitial Lung Disease Clinic

Bosch

Wang

Bakal

et al. 2022

Am J Hosp Palliat Care

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Background: Fibrotic interstitial lung diseases (F-ILDs) have a high symptom burden with progressive dyspnea as a primary feature. Breathlessness is underrecognized and undertreated primarily due to lack of consensus on how to best measure and manage it. Several nonpharmacologic and pharmacologic strategies are published in the literature, however there is a paucity of real-world data describing their systematic implementation. Objectives: We describe the types of breathlessness interventions and timing of implementation in our multidisciplinary collaborative care (MDC) ILD clinic and the impact of our approach on dyspnea trajectory and acute care use in ILD. Methods: A retrospective, observational study of deceased ILD patients seen in our clinic (2012-2018) was conducted. Patients were grouped by baseline medical research council (MRC) grade and dyspnea interventions from clinic enrolment until death were examined. Healthcare usage in the last 6 months of life was collected through Alberta’s administrative database. Results: Eighty-one deceased ILD patients were identified. Self management advice was provided to 100% of patients. Pulmonary rehabilitation (PR) and home care (HC) referrals were made in 40% and 57% of patients, respectively. Eighty percent were treated with oxygen and 53% with opioids during the study. MDC-initiated referral to PR and HC, oxygen and opioid prescriptions were provided a median of 13, 9, 11, and 4 months prior to death, respectively. Stepwise implementation of interventions was observed more commonly in MRC 1-2 and concurrent implementation in MRC 4-5. Conclusions: Our clinic’s approach allows early and systematic dyspnea management.

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“…Additionally, real-time patient health monitoring and alarming systems, facilitated by wireless sensor networks and embedded systems, have contributed to improved patient outcomes, especially for those suffering from diseases during their normal life (Al-Aubidy et al, 2016;Orieno et al, 2024). Moreover, the use of non-medical devices for chronic breathlessness, integrated into complex social systems, has highlighted the interactions of patient-carer-clinician triads and their impact on implementation and integration (Prihartadi et al, 2021). Notable lessons learned from embedded systems in medical devices include the importance of trust and security in intelligent embedded systems, particularly in ensuring privacy preservation and user trust (Yadav & Alharbi, 2021;Ezeigweneme et al, 2024).…”

Section: Case Studies and Real-world Examplesmentioning

confidence: 99%

Reviewing the Impact of Embedded Systems in Medical Devices in the Usa

Sedat Sonko,

Ayodeji Matthew Monebi,

Emmanuel Augustine Etukudoh

et al. 2024

imsrj

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The integration of embedded systems in medical devices has revolutionized the healthcare landscape in the United States, fostering advancements in patient care, diagnostics, and treatment modalities. This review provides a concise overview of the extensive review conducted to understand the multifaceted impact of embedded systems in medical devices within the USA. Embedded systems, characterized by their compact size and integration into various medical devices, play a pivotal role in enhancing the efficiency, accuracy, and functionality of healthcare technologies. This review explores the pervasive influence of embedded systems in diverse medical applications, ranging from wearable devices monitoring vital signs to sophisticated imaging equipment and life-saving implantable devices. The analysis encompasses a comprehensive examination of the regulatory landscape governing embedded medical devices in the USA, emphasizing the stringent standards set by regulatory bodies such as the Food and Drug Administration (FDA). The evolving regulatory framework reflects the ongoing efforts to balance innovation with patient safety, ensuring that embedded systems adhere to the highest standards of reliability and security. Furthermore, the review delves into case studies and real-world examples, showcasing instances where embedded systems have contributed significantly to medical breakthroughs and improved patient outcomes. The integration of artificial intelligence, data analytics, and connectivity within embedded systems has enabled healthcare professionals to access real-time patient data, facilitating timely interventions and personalized treatment plans. However, the review also addresses challenges and concerns, including cybersecurity risks and the need for standardized interoperability among different embedded systems. The potential for remote hacking and data breaches underscores the importance of robust cybersecurity measures in the rapidly evolving landscape of medical device technology. This comprehensive review sheds light on the transformative impact of embedded systems in medical devices within the USA. By examining both the positive contributions and challenges associated with these technologies, stakeholders can make informed decisions to further propel the integration of embedded systems for improved healthcare outcomes. Keywords: Embedded System, Medical, Devices, USA, Health, Review.

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Non-medical devices for chronic breathlessness: use, barriers and facilitators for patients, carers and clinicians - a scoping review

Cited by 6 publications

References 54 publications

The handheld fan for chronic breathlessness: Clinicians’ experiences and views of implementation in clinical practice

The handheld fan for chronic breathlessness: Clinicians’ experiences and views of implementation in clinical practice

A Retrospective, Descriptive Study of Dyspnea Management in a Multidisciplinary Interstitial Lung Disease Clinic

Reviewing the Impact of Embedded Systems in Medical Devices in the Usa

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