Cambridge Breathlessness Intervention Service (CBIS)

Abstract

Breathlessness is a common disabling symptom of advanced cardiorespiratory disease both malignant and non-malignant in nature. It is profoundly distressing for both patient and those who care for them, and often leads to disability, social isolation, and depression. It is extremely difficult to palliate successfully and interventions that help breathlessness are still poorly understood. Breathlessness occurs in 90% of patients with advanced chronic obstructive pulmonary disease and lung cancer and is also common in heart failure. The Cambridge Breathlessness Intervention Service was set up to deliver an evidence-based complex intervention for breathlessness and to carry out research to improve its management. The team consists of a palliative care consultant, specialist physiotherapists, a lead occupational therapist: it is part of a palliative care department at an acute hospital but sees patients in the community and carries out ward consultations. The evaluation and modelling of the service (using the Medical Research Council (MRC) methodology for research in complex interventions) has taken 10 years and has shown the value of the fan, using pacing techniques, an individualized exercise programme, breathing exercises, learning anxiety reduction techniques, and support for carers delivered with a rehabilitative approach. Recently, the Phase III evaluation of the service has demonstrated its effectiveness in reducing distress due to breathlessness in patients with lung cancer. The qualitative data also demonstrated the importance not only of the interventions themselves but also the manner in which they were delivered, i.e. that empathy; kindness and active listening were central to effective management.