Introduction
Refractory breathlessness is a disabling and distressing symptom that is common in incurable cancer and end-stage chronic cardio-respiratory illnesses. Non-pharmacological interventions have positive impacts on the individual’s perception of breathlessness and the self-efficacy of symptom management. A palliative one-point access multidisciplinary(MDT) Breathlessness Support Service(BSS) was started in PYNEH.
Objectives
(1)To enhance the self-efficacy on breathlessness management; (2)to alleviate psychological distress; (3)to improve the quality of life(QoL).
Methodology
This pilot MDT BSS consists of a short-term four half-day weekly sessions catering 4-6 patients. Participants are delivered the skills of breathing & physical exercises, energy conservation and relaxation to cope with ADL tasks, targeted psychological support, and home caring advice by the physiotherapists, occupational therapists, clinical psychologists and palliative care nurses. Pre- and post-intervention assessment were carried out to evaluate the outcome.
Results & Outcome
There were 37 participants (M:F: 27:10; 19 ONC patients, 18 MED patients) from March to December 2018. Lung cancer(43%) and COPD(32%) were the main diagnoses. The mean age was 74.2 years old(range 46-94 years). 19 patients completed the pre- and post-intervention assessments. Physiotherapy: The Six-Minutes Walk Test significantly improved from 253.0m to 312.4m(p=0.001). Occupational Therapy: Modified ADL Scale capturing the domains of personal care, domestic, physical and leisure activities recorded mixed responses. Significant better confidence was noted for the mastery of toileting(1.00±1.803, p=0.036). All ADL items in terms of “SOB”, “Exertion” and “Confidence” level could be sustained without deterioration. Clinical Psychology: Chinese Breathlessness Beliefs Questionnaire(CBBQ) reported a significant decrease on the mean scores of Somatic Focus subscale(Mdiff=4.68, SD=5.96, t(18)= 3.42, p < 0.01) and Activity Avoidance(AA) subscale(Mdiff=5.05, SD=6.20, t(18)=3.56, p < 0.01), meaning the reduction of anxiety-provoking thoughts and negative beliefs about physical activities. The self-ratings of SOB-related fear level and SOB-related anxiety level were also reduced, though statistically non-significant. The Palliative care outcome scale(POS) showed a trend towards QoL improvement (Pre-: M=8.21, SD 5.55; post- M=5.47, SD 4.81; t(18) =1.88, p=0.08). All patients rated the BSS as “excellent” in the service satisfaction survey. Conclusions: This BSS model improves the participants’ physical function, self-mastery skills on managing breathlessness to cope with ADL tasks. It can reduce the breathlessness induced emotional distress, and potentially improve the QoL.
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