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 trialReport as inadecuate




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 - Download this document for free, or read online. Document in PDF available to download.

BMC Medicine

, 12:194

First Online: 31 October 2014Received: 04 June 2014Accepted: 29 September 2014DOI: 10.1186-s12916-014-0194-2

Cite this article as: Farquhar, M.C., Prevost, A.T., McCrone, P. et al. BMC Med 2014 12: 194. doi:10.1186-s12916-014-0194-2

Abstract

BackgroundBreathlessness 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.

MethodsA 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.

ResultsBIS 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.

ConclusionsBIS appears to be more effective and cost-effective in advanced cancer than standard care.

Trial registrationRCT registration at ClinicalTrials.gov NCT00678405 May 2008 and Current Controlled Trials ISRCTN04119516 December 2008.

KeywordsBreathlessness Cancer Advanced disease Randomised controlled trial Complex intervention Mixed methods AbbreviationsBISBreathlessness Intervention Service

CIconfidence interval

CRQChronic Respiratory Questionnaire

CSRIClient Services Receipt Inventory

HADSHospital Anxiety and Depression Scale

MRCMedical Research Council

NHSNational Health Service

NRSnumerical rating scale

QALYquality-adjusted life year

RCTrandomised controlled trial

RECresearch ethics committee

SDstandard deviation

Electronic supplementary materialThe online version of this article doi:10.1186-s12916-014-0194-2 contains supplementary material, which is available to authorized users.

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Author: Morag C Farquhar - A Toby Prevost - Paul McCrone - Barbara Brafman-Price - Allison Bentley - Irene J Higginson - Chris T

Source: https://link.springer.com/







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