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

BMC Medicine

Sara Booth²  Chris Todd⁴  Irene J Higginson¹  Allison Bentley³  Barbara Brafman-Price³  Paul McCrone⁵  A Toby Prevost⁶  Morag C Farquhar⁴ 

[1] Department of Palliative Care, Policy & Rehabilitation, King’s College London, Cicely Saunders Institute, Denmark Hill, London SE5 9PJ, UK;Palliative Care Team, Cambridge University Hospitals’ NHS Foundation Trust, Addenbrooke’s Hospital, Hills Rd, Cambridge CB2 0QQ, UK;Formerly: Palliative Care Team, Cambridge University Hospitals’ NHS Foundation Trust, Addenbrooke’s Hospital, Hills Rd, Cambridge CB2 0QQ, UK;School of Nursing, Midwifery & Social Work, University of Manchester, Jean McFarlane Building, Oxford Rd, Manchester M13 9PL, UK;Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK;Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, School of Medicine, King’s College London, 7th Floor Capital House, 42 Weston Street, London SE1 3QD, UK

关键词: Mixed methods;    Complex intervention;    Randomised controlled trial;    Advanced disease;    Cancer;    Breathlessness;   

Others  :  1118280
DOI  :  10.1186/s12916-014-0194-2

 received in 2014-06-04, accepted in 2014-09-29,  发布年份 2014

【 摘 要 】

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.

Trial registration

RCT registration at ClinicalTrials.gov NCT00678405 webcite (May 2008) and Current Controlled Trials ISRCTN04119516 webcite (December 2008).

【 授权许可】

   
2014 Farquhar et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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