Background People with advanced disease often experience fatigue and breathlessness which impacts on their wellbeing (Gysels, Higginson. BMC Palliat Care. 2011; 10:15). Evidence-based, non-pharmacological, multidisciplinary breathlessness and fatigue management services have been found to improve quality of life (Booth. Prog Palliat Care. 2013; 21:4). They have not been developed or evaluated in the palliative day therapy setting.
Aims To explore the feasibility of implementing a breathlessness programme and evaluate patient experiences and outcomes.
Method The Cambridge Breathlessness Intervention Service study day was attended by a specialist palliative care physiotherapist and occupational therapist, to consolidate existing knowledge and understand the Breathing, Thinking, Functioning model (Spathis, Booth, Moffat, et al. Prim Care Resp Med. 2017; 27(1):27). A six-week group programme was designed and implemented covering breathing techniques, staying active, stress and anxiety, fatigue management, living well whilst planning for the future and guided relaxation. This took place weekly, in four hour sessions. The programme was delivered by a physiotherapist and occupational therapist, with support from nursing and medical colleagues. Demographic data and patient feedback were collected, with the Chronic Respiratory Questionnaire- Self Reported (CRQ-SR), (Williams, Singh, Sewell, et al. Thorax. 2001; 56(12): 954–9) completed at weeks one and six.
Results 44 patients were referred to the programme. 47% had a cancer diagnosis, 30% a respiratory condition, 10% cardiac failure and 13% a mixed cancer/respiratory pathology. 14 patients attended the group, over three different cohorts. 7 patients completed the entire programme and completed the PROMs. 9 patients died after referral, 4 after starting the group. The 21 referrals who did not start a group either declined the group or were not appropriate for a variety of reasons.The mean number of sessions attended was 3.5. Of those that completed the programme, CRQ-SR score had a mean improvement of 10.7 points, with the Mastery domain demonstrating a mean improvement of 3.28, where 2.0 is considered significant (Morgan. Respiratory Med. 1991; 85:23–24).
Conclusion An informal group in a day therapy setting can be an effective, acceptable and feasible method of delivering a breathlessness and fatigue management programme. This project can offer learning to those in similar settings.
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