Patient Comfort and Treatment Efficiency of Voluntary Deep Inspiration Breath Hold

Abstract

Voluntary deep inspiration breath hold (vDIBH) has been proven to be a beneficial technique to reduce heart dose in breast treatments. There are several different pieces of equipment that can be used to deliver this treatment and each should be studied for its level of comfort and reproducibility as for the overall efficiency of the treatment. This study focused on the patient comfort and treatment efficiency of vDIBH when using the MedSpira® Breath Hold ES Equipment. This was a retrospective study that compiled data from 10 patients that had been pre-selected to participate in a vDIBH pilot study. Timestamps and relevant notes from each patient’s treatment chart were recorded as well as responses from a patient satisfaction questionnaire and patient interview. Input from the treating therapists was also recorded as they provided insight into the changes that occurred and difficulties that were encountered. All of this information was recorded in an Excel document and analysed using basic statistical tests and content analysis. The average total length of time for first day treatments was 31 minutes while the average total length of time for successive treatments was 18 minutes. Steps were taken throughout treatment to improve patient comfort, such as eliminating the MedSpira® light display and relying on verbal coaching from the therapists. This was partly due to the patients reporting a difficulty of 5.75/10 on the patient questionnaire regarding difficulty following the light signals. Patients reported the clarity of breathing instructions to be an average of 8.89/10. The level of difficulty of the vDIBH treatment decreased from a 2.78/10 in the first week to a 1.44/10 in the final week. A first day appointment time of 1 hour is acceptable while successive days may be able to be reduced from 45 minutes to 30 minutes. Overall the process was already very efficient with only a few suggestions provided to improve efficiency such as eliminating the drawing of a lateral DIBH mark every day on the treatment unit and tattooing the anterior DIBH mark in CT. Patients who were exposed to the verbal coaching preferred that over the Medspira® light system as they did not find the light system an accurate representation of their breath hold. Patients also relied heavily on the feedback from the therapists and trusted their decisions therefore it is imperative to have confident and knowledgeable therapists delivering these treatments. One recommendation that arose from the analysis of this study was to create a video to teach patients how to breath properly and how to practice prior to their treatment.