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Is a specialist breathlessness service more effective and cost-effective for patients with advanced cancer and their carers than standard care? Findings of a mixed-method randomised controlled trial

Title: Is a specialist breathlessness service more effective and cost-effective for patients with advanced cancer and their carers than standard care? Findings of a mixed-method randomised controlled trial
Authors: Farquhar, MC
Prevost, AT
McCrone, P
Brafman-Price, B
Bentley, A
Higginson, IJ
Todd, C
Booth, S
Item Type: Journal Article
Abstract: Background Breathlessness is common in advanced cancer. The Breathlessness Intervention Service (BIS) is a multi-disciplinary complex intervention theoretically underpinned by a palliative care approach, utilising evidence-based non-pharmacological and pharmacological interventions to support patients with advanced disease. We sought to establish whether BIS was more effective, and cost-effective, for patients with advanced cancer and their carers than standard care. Methods A single-centre Phase III fast-track single-blind mixed-method randomised controlled trial (RCT) of BIS versus standard care was conducted. Participants were randomised to one of two groups (randomly permuted blocks). A total of 67 patients referred to BIS were randomised (intervention arm n = 35; control arm n = 32 received BIS after a two-week wait); 54 completed to the key outcome measurement. The primary outcome measure was a 0 to 10 numerical rating scale for patient distress due to breathlessness at two-weeks. Secondary outcomes were evaluated using the Chronic Respiratory Questionnaire, Hospital Anxiety and Depression Scale, Client Services Receipt Inventory, EQ-5D and topic-guided interviews. Results BIS reduced patient distress due to breathlessness (primary outcome: -1.29; 95% CI -2.57 to -0.005; P = 0.049) significantly more than the control group; 94% of respondents reported a positive impact (51/53). BIS reduced fear and worry, and increased confidence in managing breathlessness. Patients and carers consistently identified specific and repeatable aspects of the BIS model and interventions that helped. How interventions were delivered was important. BIS legitimised breathlessness and increased knowledge whilst making patients and carers feel `not alone’. BIS had a 66% likelihood of better outcomes in terms of reduced distress due to breathlessness at lower health/social care costs than standard care (81% with informal care costs included). Conclusions BIS appears to be more effective and cost-effective in advanced cancer than standard care.
Issue Date: 31-Oct-2014
Date of Acceptance: 29-Sep-2014
URI: http://hdl.handle.net/10044/1/71697
DOI: https://doi.org/10.1186/s12916-014-0194-2
ISSN: 1741-7015
Publisher: BioMed Central
Journal / Book Title: BMC Medicine
Volume: 12
Issue: 1
Copyright Statement: © 2014 Farquhar et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Sponsor/Funder: NIHR Research for Patient Benefit
Funder's Grant Number: PB-PG-0107-11134
Keywords: Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
Breathlessness
Cancer
Advanced disease
Randomised controlled trial
Complex intervention
Mixed methods
QUALITY-OF-LIFE
LUNG-CANCER
PALLIATIVE CARE
NONPHARMACOLOGICAL INTERVENTION
COMPLEX INTERVENTION
MANAGEMENT
DYSPNEA
DISEASE
Adult
Aged
Aged, 80 and over
Anxiety
Caregivers
Cost-Benefit Analysis
Dyspnea
Female
Health Care Costs
Humans
Male
Middle Aged
Neoplasms
Occupational Therapy
Outcome Assessment (Health Care)
Palliative Care
Physical Therapy Modalities
Single-Blind Method
Surveys and Questionnaires
Humans
Neoplasms
Dyspnea
Palliative Care
Occupational Therapy
Single-Blind Method
Anxiety
Adult
Aged
Aged, 80 and over
Middle Aged
Caregivers
Cost-Benefit Analysis
Health Care Costs
Outcome Assessment (Health Care)
Female
Male
Physical Therapy Modalities
Surveys and Questionnaires
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
Breathlessness
Cancer
Advanced disease
Randomised controlled trial
Complex intervention
Mixed methods
QUALITY-OF-LIFE
LUNG-CANCER
PALLIATIVE CARE
NONPHARMACOLOGICAL INTERVENTION
COMPLEX INTERVENTION
MANAGEMENT
DYSPNEA
DISEASE
11 Medical and Health Sciences
General & Internal Medicine
Publication Status: Published
Article Number: 194
Online Publication Date: 2014-10-31
Appears in Collections:School of Public Health