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Table 1 Service model for the Breathlessness Intervention Service (BIS) for non-malignant patients at Phase II RCT (model date: 15/12/06: since revised)

From: The feasibility of a single-blinded fast-track pragmatic randomised controlled trial of a complex intervention for breathlessness in advanced disease

Target patient group: Refractory dyspnoea – chronic breathlessness which is medically optimally managed
Referral: Post, fax, electronic
Assessment lead: Clinical Specialist Physiotherapist
BIS team:    ❑ Clinical Specialist Physiotherapist: expert in three different disease groups (cancer, heart failure, COPD), conducts highly specialised assessment, works off-site and on-site.
     ❑ Palliative Medical Consultant
Medical assessment: May be required
Average no. of home visits: 3
Average no. of telephone contacts: 3
Ratio of face-to-face to telephone: 1:1
Average length of service contact: 6–8 weeks
Outcome measures collected at first assessment:    ❑ modified Borg [19] at rest, self-reported, on exertion completion of exercise test
     ❑ anxiety due to breathlessness at rest, self reported, on exertion & on completion of exercise test
     ❑ physiological measures e.g. oxygen saturation, heart rate & respiratory rate
Non-pharmacological interventions: 1st stage of intervention
Pharmacological interventions: 2nd stage of intervention
1st stage interventions (selection & application as clinically indicated, majority used):    ❑ explanation & reassurance
     ❑ anxiety management
     ❑ psychological support
     ❑ hand-held fan
     ❑ information fact sheets
     ❑ emergency plan
     ❑ positioning to reduce work of breathing (rest, recovery & activity)
     ❑ breathing control
     ❑ education to patient, carer & health care generalists
     ❑ pacing & lifestyle adjustment
     ❑ individualised exercise plan
     ❑ relaxation & visualisation
     ❑ airway clearance techniques
     ❑ advice regarding nutrition & hydration
     ❑ support to family & patient to utilise education & self-support programmes
     ❑ sleep hygiene
     ❑ smoking cessation prompt
     ❑ brief cognitive therapy
     ❑ pharmacological review
2nd stage interventions (choice dependent on outcome of first stage interventions):    ❑ further pharmacological review e.g. low dose opioids, anti-depressants, anxiolytics
     ❑ referral to specialist services (see below)
     ❑ referral for long term oxygen therapy (LTOT) or short burst oxygen therapy (SBOT) assessment
Other symptom management: May be required
Documentation:    ❑ individualised patient plan
     ❑ discharge summary to referrer with copies to GP, specialist services the patient was already in contact with (e.g. respiratory physicians), other involved health care professionals (e.g. district nurses, nursing home care staff)
Referrals:    ❑ Pulmonary rehabilitation
     ❑ Specialist dietetic
     ❑ OT advice
     ❑ Specialist psychological services
     ❑ Hospice day services
     ❑ other specialist assessment
     ❑ (n.b. these services usually have a wait time)