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An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: a randomised controlled trial
Open accessAbstract
BACKGROUND: Breathlessness is a common and distressing symptom, which increases in many diseases as they progress and is difficult to manage. We assessed the effectiveness of early palliative care integrated with respiratory services for patients with advanced disease and refractory breathlessness. METHODS: In this single-blind randomised trial, we enrolled consecutive adults with refractory breathlessness and advanced disease from three large teaching hospitals and via general practitioners in South London. We randomly allocated (1:1) patients to receive either a breathlessness support service or usual care. Randomisation was computer generated centrally by the independent Clinical Trials Unit in a 1:1 ratio, by minimisation to balance four potential confounders: cancer versus non-cancer, breathlessness severity, presence of an informal caregiver, and ethnicity. The breathlessness support service was a short-term, single point of access service integrating palliative care, respiratory medicine, physiotherapy, and occupational therapy. Research interviewers were masked as to which patients were in the treatment group. Our primary outcome was patient-reported breathlessness mastery, a quality of life domain in the Chronic Respiratory Disease Questionnaire, at 6 weeks. All analyses were by intention to treat. Survival was a safety endpoint. This trial is registered with ClinicalTrials.gov, number NCT01165034. FINDINGS: Between Oct 22, 2010 and Sept 28, 2012, 105 consenting patients were randomly assigned (53 to breathlessness support service and 52 to usual care). 83 of 105 (78%) patients completed the assessment at week 6. Mastery in the breathlessness support service group improved compared with the control (mean difference 0·58, 95% CI 0·01-1·15, p=0·048; effect size 0·44). Sensitivity analysis found similar results. Survival rate from randomisation to 6 months was better in the breathlessness support service group than in the control group (50 of 53 [94%] vs 39 of 52 [75%]) and in overall survival (generalised Wilcoxon 3·90, p=0·048). Survival differences were significant for patients with chronic obstructive pulmonary disease and interstitial lung disease but not cancer. INTERPRETATION: The breathlessness support service improved breathlessness mastery. Our findings provide robust evidence to support the early integration of palliative care for patients with diseases other than cancer and breathlessness as well as those with cancer. The improvement in survival requires further investigation. FUNDING: UK National Institute for Health Research (NIHR) and Cicely Saunders International.
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“Such services provide a brief, cost-effective intervention that impacts positively on distress from breathlessness, mastery, quality of life, and even survival.”
From The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease (2017) · cites this paper as [26]
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Self-citation
Metadata
- Authors
- Higginson, I. J., Bausewein, C., Reilly, C. C., Gao, W., Gysels, M., Dzingina, M., McCrone, P., Booth, S., Jolley, C. J., & Moxham, J.
- Affiliations
- King's College London (GB)
- Cambridge University Hospitals NHS Foundation Trust (GB)
- ORCID
- Venue
- The Lancet Respiratory Medicine
- Publisher
- Elsevier BV
- Published
- 2014-12
- Volume
- 2
- Issue
- 12
- Pages
- 979-987
- ISSN
- 2213-2600 (ISSN-L)
- OpenAlex
- W2098206882
- Cited by
- 605
- References
- 44
- Citations by year
- 2026: 23 · 2025: 36 · 2024: 36 · 2023: 47 · 2022: 46 · 2021: 68 · 2020: 51 · 2019: 68 · 2018: 64 · 2017: 69 · 2016: 57 · 2015: 39 · 2014: 1
- FWCI
- 54.89
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- The Lancet Respiratory Medicine (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UvA-DARE (University of Amsterdam) (publishedVersion, other-oa)
- UvA-DARE (University of Amsterdam) (submittedVersion, other-oa)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Research for Patient Benefit (PBPG-0808-17311)
- NIHR under its Research for Patient Benefit (RfPB) programme (PB-PG-0808-17311)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- refractory breathlessness, palliative care, advanced disease, chronic obstructive pulmonary disease, interstitial lung disease, survival, quality of life, physiotherapy, occupational therapy, early integration of palliative care, symptom management, usual care comparison, informal caregivers, ethnicity, Chronic Respiratory Questionnaire
- MeSH terms
- Adult, Chronic Disease, Dyspnea, Heart Failure, Humans, Palliative Care, Quality of Life, Respiratory Therapy, Single-Blind Method, Motor Neuron Disease, Treatment Outcome, Lung Diseases, Interstitial, Pulmonary Disease, Chronic Obstructive
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