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Luckett T, Roberts M, Smith T, Garcia M, Dunn S, Swan F, Ferguson C, Kochovska S, Phillips JL, Pearson M, Currow DC, Johnson MJ. Implementing the battery-operated hand-held fan as an evidence-based, non-pharmacological intervention for chronic breathlessness in patients with chronic obstructive pulmonary disease (COPD): a qualitative study of the views of specialist respiratory clinicians. BMC Pulm Med 2022; 22:129. [PMID: 35387636 PMCID: PMC8985391 DOI: 10.1186/s12890-022-01925-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/25/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction The battery-operated hand-held fan (‘fan’) is an inexpensive and portable non-pharmacological intervention for chronic breathlessness. Evidence from randomised controlled trials suggests the fan reduces breathlessness intensity and improves physical activity in patients with a range of advanced chronic conditions. Qualitative data from these trials suggests the fan may also reduce anxiety and improve daily functioning for many patients. This study aimed to explore barriers and facilitators to the fan’s implementation in specialist respiratory care as a non-pharmacological intervention for chronic breathlessness in patients with chronic obstructive pulmonary disease (COPD). Methods A qualitative approach was taken, using focus groups. Participants were clinicians from any discipline working in specialist respiratory care at two hospitals. Questions asked about current fan-related practice and perceptions regarding benefits, harms and mechanisms, and factors influencing its implementation. Analysis used a mixed inductive/deductive approach. Results Forty-nine participants from nursing (n = 30), medical (n = 13) and allied health (n = 6) disciplines participated across 9 focus groups. The most influential facilitator was a belief that the fan’s benefits outweighed disadvantages. Clinicians’ beliefs about the fan’s mechanisms determined which patient sub-groups they targeted, for example anxious or palliative/end-stage patients. Barriers to implementation included a lack of clarity about whose role it was to implement the fan, what advice to provide patients, and limited access to fans in hospitals. Few clinicians implemented the fan for acute-on-chronic breathlessness or in combination with other interventions. Conclusion Implementation of the fan in specialist respiratory care may require service- and clinician-level interventions to ensure it is routinely recommended as a first-line intervention for chronic breathlessness in patients for whom this symptom is of concern, regardless of COPD stage.
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Affiliation(s)
- Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Building 10, Level 3, 235 Jones St, Ultimo, Sydney, NSW, 2007, Australia.
| | - Mary Roberts
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, NSW, Australia.,Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Sydney, NSW, Australia.,The University of Sydney at Westmead Hospital, Sydney, NSW, Australia
| | - Tracy Smith
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, NSW, Australia.,The University of Sydney at Westmead Hospital, Sydney, NSW, Australia
| | - Maja Garcia
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Building 10, Level 3, 235 Jones St, Ultimo, Sydney, NSW, 2007, Australia
| | - Sarah Dunn
- Respiratory Medicine Clinic, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Flavia Swan
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston Upon Hull, Yorkshire, UK
| | - Caleb Ferguson
- Western Sydney Nursing & Midwifery Research Centre, Blacktown Clinical & Research School, Western Sydney Local Health District, Western Sydney University, Blacktown Hospital, Sydney, NSW, Australia
| | - Slavica Kochovska
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Building 10, Level 3, 235 Jones St, Ultimo, Sydney, NSW, 2007, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Building 10, Level 3, 235 Jones St, Ultimo, Sydney, NSW, 2007, Australia.,School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston Upon Hull, Yorkshire, UK
| | - David C Currow
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Building 10, Level 3, 235 Jones St, Ultimo, Sydney, NSW, 2007, Australia.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston Upon Hull, Yorkshire, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston Upon Hull, Yorkshire, UK
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