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)

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:

1^st stage of intervention

Pharmacological interventions:

2^nd stage of intervention

1^st 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

2^nd 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)