Science supporting the art of medicine: improving the management of breathlessness

Booth, Sara

doi:10.1177/0269216313488490

Cited by 20 publications

(17 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…BIS reportedly made a positive difference to 94% of patients and carers with impacts including reduced fear and worry, and increased confidence about breathlessness. Patients and carers consistently noted specific, identifiable and repeatable aspects of the BIS model and a range of interventions they found helpful in reducing the impact of breathlessness, many of which suggest modulation of central perception [15,36]. Although a list of interventions the participants found beneficial is useful, the way these interventions were delivered was important.…”

Section: Discussionmentioning

confidence: 97%

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

et al. 2014

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 97%

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

et al. 2014

Self Cite

View full text Add to dashboard Cite

show abstract

“…These suggestions continue to require attention, given that the real advances that have been made to better understand the mechanism of the problem and ways to optimally palliate it. 36,37 The majority of patients at the time they were identified as dying were fully dependant and barely able to be roused reinforcing their very poor performance status with this a reliable prognostic indicator for patients with cancer. 38 There was, however, a very small group of people who were allocated a much higher level of function.…”

Section: Discussionmentioning

confidence: 99%

Physical Symptoms at the Time of Dying Was Diagnosed: A Consecutive Cohort Study To Describe the Prevalence and Intensity of Problems Experienced by Imminently Dying Palliative Care Patients by Diagnosis and Place of Care

Clark

Connolly

Clapham

et al. 2016

Journal of Palliative Medicine

View full text Add to dashboard Cite

show abstract

“…Dyspnoea can be defined as the subjective experience of discomfort in breathing. It is a complex symptom and a distressing sensation of both body and mind [Booth, 2013]. A common presentation of a wide range of diseases, it has been identified as a potent predictor of mortality and hospitalization [Parshall et al 2012].…”

Section: Mixed Messagesmentioning

confidence: 99%

Oxygen therapy: time to move on?

Kelly

2014

Ther Adv Respir Dis

View full text Add to dashboard Cite

This analysis examines the roots of clinical practice regarding oxygen therapy and finds that some aspects have changed very little over the past 200 years. Oxygen is commonly prescribed and administered as a therapy across all healthcare settings, particularly for the treatment and management of respiratory conditions, both acute and chronic. Yet despite its widespread use and recent advances in understanding and guidance, poor practice and controversies regarding its use persist. This historical analysis highlights origins in practice that may suggest where the roots of these fallacies lie, highlighting potential ambiguities and myths that have permeated clinical and social contexts. It can be considered that based on clinical presumptions and speculation the prolific and injudicious use of oxygen was encouraged and the legacy for today's practice seeded. The conjectures proposed here may enable modern day erroneous beliefs to be confronted and clinical practice to move on.

show abstract

Science supporting the art of medicine: improving the management of breathlessness

Cited by 20 publications

References 5 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

Physical Symptoms at the Time of Dying Was Diagnosed: A Consecutive Cohort Study To Describe the Prevalence and Intensity of Problems Experienced by Imminently Dying Palliative Care Patients by Diagnosis and Place of Care

Oxygen therapy: time to move on?

Contact Info

Product

Resources

About