An Integrated Breathlessness Service Program in an Ambulatory Hospice Center- Sharing of Local Experience and Clinical Results

Abstract

Background:To improve patients’ breathlessness and relieve their distress and anxiety. Methods:PROACTIVE group targets the lung cancer patients without significant breathlessness. These high-risk patients with their families will have proactive education on the measures for self-management on breathlessness so as to reduce its impact in due course. Patient’s self- efficacy in mastering breathlessness are related to their predominant place of care at their last 6 months of life, their frequency of unplanned hospital admission and emergency unit attendance for the management of breathlessness.THERAPEUTIC group recruits those cancer patients with significant breathlessness. The patient will have an Individual Comprehensive Breathlessness Assessment. Personalized pharmacological and non-pharmacological Interventions will be used. The care-givers will be empowered by providing relevant information and training up of their caring skills. Patient’s self-rating symptom control, stress and confident scores were regularly monitored on every visit. The absolute changes of self-rating scores during their disease course were recorded. Results:Total 292 patients have been recruited (Proactive 227; Therapeutic 65) and retrospective analyzed. In the Proactive group, 76.5% patients remained in community as their predominant place of care at their last 6 months of life. Their mean frequencies of unplanned hospital admission and emergency unit attendance per patient are 1.1 and 1.44, respectively (Corresponding local data were 2.5 and 3.4). In the Therapeutic group, 85% patients had moderate to high level breathlessness score at presentation which greatly affects their quality of life {significant emotion stress (34%) and unconfident feeling (50%)}. 78% patients had 3 or less attendances due to their rapid clinical deterioration. The interventions are effective in improving or stabilizing both breathless patient’s physical (44%/26%) and psychological status {emotional stress (17%/46%) and confident score (24%/28%)} despite their disease progressing.Conclusion:This Integrated Breathless Service Program is effective in improving both patients’ physical and psychological status. Adopting a proactive approach can equip the high-risk patients and their care-givers with knowledge and skills for handling breathlessness when in need. Hence this facilitates timely intervention especially when cancer patients tend to deteriorate rapidly that sometimes the therapeutic interventions may not have time to practice.