The importance of the feasibility study: Lessons from a study of the hand-held fan used to relieve dyspnea in people who are breathless at rest

Booth, Sara; Galbraith, Sarah; Ryan, Richella; Parker, Richard; Johnson, Miriam J.

doi:10.1177/0269216315607180

Cited by 28 publications

(55 citation statements)

References 19 publications

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“…A recent systematic review6 included a meta-analysis of fan at rest which showed improved subjectively reported breathlessness 6. An observational feasibility study that showed approximately half of the participants with breathlessness at rest gained a benefit from fan use that persists until further exertion 7. In a feasibility randomised controlled trial (RCT), more participants still used the fan for breathlessness after 2 months than those in the control intervention 8.…”

Section: Introductionmentioning

confidence: 99%

Battery operated fan and chronic breathlessness: does it help?

Barnes-Harris

Allgar

Booth

et al. 2019

BMJ Support Palliat Care

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ObjectivesTo examine whether use of a hand-held fan (‘fan’) improves breathlessness and increases physical activity.MethodsA secondary exploratory analysis using pooled data from the fan arms of two feasibility randomised controlled trials in people with chronic breathlessness: (1) fan and activity advice vs activity advice, (2) activity advice alone or with the addition or the ‘calming hand’, or the fan, or both. Descriptive statistics and regression analysis to explore patient characteristics associated with benefit (eg age, sex, diagnosis, general self-efficacy).ResultsForty-one participants were allocated the fan (73 years (IQR 65–76, range 46–88), 59% male, 20 (49%) chronic obstructive pulmonary disease (COPD), three (7%) heart failure, three (7%) cancer). Thirty-five (85%) reported that the fan helped breathing, and 22 (54%) reported increased physical activity.Breathlessness benefit was more likely in older people, those with COPD and those with a carer. However, due to the small sample size none of these findings were statistically significant. Those with COPD were more likely to use the fan than people with other diagnoses (OR 5.94 (95% CI 0.63 to 56.21, p=0.120)).ConclusionsThese exploratory data support that the fan helps chronic breathlessness in most people and adds new data to indicate that the fan is perceived to increase people’s physical activity. There is also a signal of possible particular benefits in people with COPD which is worthy of further study.

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Section: Introductionmentioning

confidence: 99%

Battery operated fan and chronic breathlessness: does it help?

Barnes-Harris

Allgar

Booth

et al. 2019

BMJ Support Palliat Care

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“…The rationale for using 5 minutes of directed airflow was based on previous studies that achieved symptom palliation with this duration. [30][31][32] Like previous studies, the distance, location, side of face, strength, and swing of the fan was determined as per the patient's preference. 30,31 A standing fan placed on the floor was initially turned on at the lowest speed and was gradually adjusted to increase the speed and strength of the fan breeze.…”

Section: Interventions and Proceduresmentioning

confidence: 99%

“…[30][31][32] Like previous studies, the distance, location, side of face, strength, and swing of the fan was determined as per the patient's preference. 30,31 A standing fan placed on the floor was initially turned on at the lowest speed and was gradually adjusted to increase the speed and strength of the fan breeze. In the control arm, airflow was directed unto the legs with the patient's skin exposed for 5 minutes using the same model of the fan as that used in the intervention arm.…”

Section: Interventions and Proceduresmentioning

confidence: 99%

“…21 This study is designed to fill in the gap of fan therapy in Filipino patients with advanced cancer, as most previous studies were targeted on the Western population. [22][23][24][25][26][27][28][29][30][31] Alleviating dyspnea in terminally ill cancer patients is a major concern, as one of the goals of palliative care is to provide comfort to the patient. Given the low cost, practical convenience, and immediate response of this approach if proven effective with no adverse effects, a clinical trial evaluating the effectiveness of fan therapy to terminally ill Filipino cancer patients will be of great value.…”

Section: Introductionmentioning

confidence: 99%

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The FAFA Trial: A Phase 2 Randomized Clinical Trial on the Effect of a Fan Blowing Air on the Face to Relieve Dyspnea in Filipino Patients with Terminal Cancer

Ting

Estreller

Strebel

2020

Asian Journal of Oncology

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Introduction Fan therapy has been suggested by some studies as one of the nonpharmacological supportive interventions to alleviate breathlessness for dyspneic patients with terminal cancer. Unfortunately, data among Asians are limited and there are currently no published data showing that this intervention works among Filipinos—thus this study. Study Design This study was an open-label, randomized, placebo-controlled, crossover Phase 2 trial. The experimental group had a fan blowing air directly to the patient’s face for 5 minutes, and the control group had a fan blowing air to the patient’s legs. Treatment crossover was done after a washout period of 1 hour. The primary outcome, which is dyspnea, was measured subjectively using the Modified Borg Scale (MBS). Differences in the patient’s respiratory rate (RR) and oxygen saturation were also measured. Results A total of 48 patients were enrolled in this trial. The mean age of the patients enrolled was 51 years, and the most common primary tumor was lung cancer (21%). In the control group, results showed that the mean difference before and after intervention in the MBS was 0.15, and the mean difference in RR was 0.25. On the other hand, the intervention group showed a statistically significant decrease in the patient’s dyspnea as evidenced by a mean MBS decrease of 2.79 (p < 0.0001), and a mean RR decrease of 1.88 (p < 0.0001). Conclusion The results of this study reveal that fan on face (FAFA) therapy in terminally ill Filipino cancer patients in addition to the prescribed standard of care can significantly alleviate their level of dyspnea. Thus, FAFA therapy should be considered as an adjunct to standard of care for these patients.

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“…By providing a steady airflow that cools down the surface temperature of the skin, fan-on-face therapy creates an environment which may optimize the breathing conditions of terminally-ill cancer patients. 20 Lastly, because of its uncomplicated nature, fanon-face therapy is generally safe, and gives patients and their caregivers the opportunity to actively and effectively manage dyspnea during the end of life.…”

Section: Conclusion and Recommendationmentioning

confidence: 99%

Fan-on-Face Therapy in Relieving Dyspnea of Adult Terminally Ill Cancer Patients: A Meta-Analysis

Mendoza

Ting

Vergara

et al. 2020

ASJO

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Abstract Introduction Dyspnea is often encountered in terminally ill cancer patients and is attributed to multiple factors. The use of fan-on-face therapy is a nonpharmacologic adjunct treatment for adult cancer patients suffering from dyspnea at the end-of-life. This study was done to determine if the use of fan-on-face therapy in addition to the standard of care treatment indeed confers clinical benefit to terminally ill adult cancer patients with dyspnea. Materials and Methods A meta-analysis of randomized controlled trials on the use of fan-on-face therapy in relieving dyspnea among terminally ill adult cancer patients was performed. A computerized search was done in MEDLINE, NICE, CENTRAL, Science Direct, and Google Scholar for relevant articles. Other publications were searched, and authors were contacted for additional information. The primary outcome measure was the mean change in dyspnea score, determined by the Modified Borg Scale, Numeric Rating Scale, or Visual Analog Scale. The secondary outcome was the post-intervention mean change in respiratory rate (RR). Results Four eligible randomized controlled trials of low to moderate risk of bias employed a total of 139 cancer patients. Fan-on-face therapy was effective in decreasing mean dyspnea scores (standard mean difference = −1.81, 95% confidence interval [CI]: −3.12, −0.50, p < 0.00001, I 2 93%) and improving mean change in RR (mean difference = −0.91, 95% CI: −1.68, −0.15; p = 0.001, I 2 = 81%) versus control. Conclusion Fan-on-face therapy, as an adjunct to standard of care, is effective in alleviating dyspnea among adult cancer patients during the end of life.

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The importance of the feasibility study: Lessons from a study of the hand-held fan used to relieve dyspnea in people who are breathless at rest

Abstract: Feasibility work is essential, even for simple widely employed interventions.

Cited by 28 publications

References 19 publications

Battery operated fan and chronic breathlessness: does it help?

Battery operated fan and chronic breathlessness: does it help?

The FAFA Trial: A Phase 2 Randomized Clinical Trial on the Effect of a Fan Blowing Air on the Face to Relieve Dyspnea in Filipino Patients with Terminal Cancer

Fan-on-Face Therapy in Relieving Dyspnea of Adult Terminally Ill Cancer Patients: A Meta-Analysis

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