Background Respiratory disease affects 1 in 5 people and is the third biggest cause of death in England. Both British Thoracic Society (BTS, 2013) and NICE guidelines advocate the use of pulmonary rehabilitation. However, research shows that those people with advanced disease struggle to complete pulmonary rehabilitation despite evidence confirming significant benefits. The Breathlessness Service at this hospice regularly encountered patients with end stage disease who either declined or were unable to access NHS pulmonary rehabilitation. Despite a high symptom burden, patients with respiratory disease remain under-represented in palliative care. Research suggests that by integrating pulmonary rehabilitation with palliative care, symptom burden can effectively be addressed in a holistic, patient centered manner.
Aim To set up a hospice-based breathlessness rehabilitation service which will provide patients with advanced disease a supportive environment in which to exercise and learn self-management techniques.
Methods A literature search was conducted confirming the evidence base for a palliative pulmonary rehabilitation group. Using BTS and NICE guidance, a 6 week programme of 2 hour sessions was devised consisting of circuit based exercises, education topics and relaxation sessions. Using an existing cohort of patients, a pilot group was formed, completing the first ‘Take a Breath’ course in February.
Results Patients demonstrated improvements both subjectively and objectively. Data was collected using a modified Chronic Respiratory Questionnaire (CRQ), Phase of Illness, Karnofsky Performance Scale, Timed Up and Go and a patient feedback questionnaire.
Conclusions This course is an effective example of rehabilitative palliative care, and also importantly provides an introduction and route into hospice care. For many of these patients, ‘Take a Breath’ has been their first experience of hospice care and has allowed them to go and make further links with the wider hospice MDT. Further audit into the longer term benefits would be beneficial, in terms of symptom control, self-management and also ongoing engagement with palliative care services.
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