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163 The handheld fan in clinical practice; a survey of clinicians’ experience of implementation and barriers to use
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  1. Gamze Keser,
  2. Ann Hutchinson,
  3. Daisy Janssen,
  4. Miriam J Johnson and
  5. Flavia Swan
  1. Wolfson Palliative Care Research Centre, Hull York Medical School, UK; Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands

Abstract

Background Studies consistently report patient benefit from fan use for relief of chronic breathlessness, but little is known about clinician implementation of the fan.

Methods Online, short, cross-sectional surveys of clinicians working with breathless patients to assess fan use and barriers to implementation. Two versions (English and Dutch) were sent out and publicised via professional groups and social media.

Results 271/302 [90%] of UK based respondents practiced in the UK and 117/125 [94%] of Dutch respondents practiced in the Netherlands. Overall, 301/484 [62.2%] respondents (11% male; 89% women; 87% >5 years’ experience) used a fan ‘some’ or ‘a lot of the time’; more common in the UK (256/302 [84.8%] vs 45/182 [24.7%]). More UK-based respondents were physiotherapists (UK 75/262 [28.6%] vs Dutch 5/125 [4.0%]), but equal proportions of nurses and doctors. Palliative care was equally represented, but respiratory clinicians were more common in the UK group (153/261 [58.6%] vs 36/124 [29%]), and elderly care in the Dutch group (22/124 [17.7%] vs 1/261 [0.4%]). The two most common barriers to fan-use were poor availability (52/231 [22.5%] and lack of funds to buy fans ([45/231 [19.5%]); one-third asking the patient to buy one for themselves. In the Dutch group only, lack of belief of effectiveness and a preference for other interventions (inhalers or oxygen) also acted as barriers.

Conclusion Most UK-based respondents recommended fan use to patients, whereas a minority of Dutch respondents did. Barriers to fan use include lack of availability and funds to buy fans, and in the Dutch group lack of belief in effectiveness. In order to improve patient access to fans we recommend that a budget be made available to clinicians to buy them. The proportion of physiotherapist respondents in the Dutch group was notably smaller; professionals likely to recommend a non-pharmacological intervention. Physiotherapists may be important in driving implementation in the UK.

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