Individual experiences and impacts of a physiotherapist-led, non-pharmacological breathlessness programme for patients with intrathoracic malignancy: a qualitative study

Our plain-English summary of Individual experiences and impacts of a physiotherapist-led, non-pharmacological breathlessness programme for patients with intrathoracic malignancy: a qualitative study, by H. Wood, S. Connors, S. Dogan, et al (Palliative Medicine, 2013).

The study

• Authors: H. Wood, S. Connors, S. Dogan, T. Peel
• Journal: Palliative Medicine
• Published: 2013;27(6):499-507
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Non-pharmacological breathlessness management programmes have been shown to be beneficial in the management of lung cancer-related dyspnoea for more than 10 years. What is not so clear is how they work.

Aim: To evaluate how patients with intrathoracic malignancy (lung cancer or pleural mesothelioma) undergoing the non-pharmacological breathlessness management programmes benefited from the programme, using a qualitative methodology.

Design And Setting: Consecutive patients completing the programme were invited to be interviewed (semi-structured and audio-recorded) about their experiences of the programme, what had helped them and how. Interviews were transcribed and analysed using interpretative phenomenological analysis.

Results: Nine patients were interviewed. Seven major themes emerged, they are summarised as follows: (1) Mixed prior expectations of the programme, (2) flexibility of delivery and additional support needs, (3) physiotherapist attributes and skills in developing an effective helping relationship, (4) adoption of new techniques, (5) the effects and impact of the programme and new techniques, (6) difficulties and barriers to achieving change and (7) facing an uncertain future beyond the programme.

Conclusion: The non-pharmacological breathlessness management programme appears to offer a wide range of benefits to patients, including improving functional capacity, coping strategies and self-control. Such benefits are most likely to be due to a combination of breathing control, activity management and the therapist qualities.

In plain English

This qualitative interview study, from North Tyneside General Hospital in the UK, asked patients with intrathoracic malignancy (lung cancer or pleural mesothelioma) about a physiotherapist-led breathlessness programme that did not use drugs. The programme taught breathing control, activity planning and pacing, energy conservation, relaxation and use of a hand-held fan. Over 6 months, 20 referred patients met the criteria. Four died during the programme, 16 were invited and 9 took part: six with mesothelioma, two with non-small cell lung cancer and one with small cell lung cancer. The study did not look at asbestos exposure. Every participant described using the breathing techniques and put great emphasis on the relationship with the physiotherapist. Participants reported more endurance, a sense of normality, more personal control and less fear and panic, and some reported easier breathing. Some found old habits hard to change and said the techniques needed practice and concentration. The authors concluded that the programme improved functional capacity and sense of control. They noted that fewer than half of referred patients were interviewed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Qualitative study using semi-structured, audio-recorded interviews analysed with interpretative phenomenological analysis
• Who was studied: Patients with intrathoracic malignancy (lung cancer or pleural mesothelioma) referred to the programme at North Tyneside General Hospital, UK, over a 6-month recruitment period (dates not given). 20 met the criteria; 4 died during the intervention, 16 were invited, 4 declined, 3 did not respond and 9 were interviewed. The 9 had a mean age of 70 (range 56 to 80); 7 were male and 2 female; 6 had mesothelioma, 2 non-small cell lung cancer and 1 small cell lung cancer. All were in the palliative stages of disease.
• Exposure: Asbestos exposure was not studied. What was studied was a physiotherapist-led, non-pharmacological breathlessness programme: a pre-programme session, four weekly sessions at home or in hospital, and a one-month follow-up. It covered breathing control, activity planning and pacing, energy conservation, relaxation and advice on a hand-held fan. Of the 9 participants, 5 had 4 sessions, 2 had 3 and 2 had 2.
• Main results:
  • Seven themes emerged from the interviews with the 9 participants: mixed prior expectations; flexibility of delivery and support needs; physiotherapist attributes and skills; adoption of new techniques; effects and impact of the programme; difficulties and barriers to change; and facing an uncertain future.
  • All participants emphasised the interpersonal side of the programme, including the physiotherapist's personal qualities, communication and listening skills, and hands-on teaching.
  • All participants described using the breathing control techniques they were taught. Participants also described using activity management, relaxation cues such as dropping the shoulders, and a fan.
  • Participants reported effects including increased endurance, perceived improved breathing, a sense of normality, more personal control over breathlessness, and reduced distress.
  • Some participants found the techniques hard to apply because of lifetime habits and the practice, effort and concentration required.
  • Two individuals commented on the benefit of a hand-held fan.
  • Participants acknowledged uncertainty about the future, and many preferred to focus on the short term.
• The authors' conclusion: The authors concluded that the physiotherapist-led programme improved functional capacity and helped patients establish a sense of control and normality. They attributed these effects to a combination of breathing control strategies, activity management and physiotherapist factors.
• Limitations the authors state:
  • Fewer than half of the referred patients were interviewed. Those who died or declined may have had different needs and experiences.
  • The study could not fully address whether a non-pharmacological approach is suitable for patients near the end of life.
  • The study covered only patients' experiences, not those of family members and carers.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Intrathoracic, Lung Cancer, Pleural Mesothelioma, Flexibility.

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