A nursing intervention to assist in the management of breathlessness Meeting with Community Partners, Bayshore Friday November 9 th, 2007 Cathy
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1 A nursing intervention to assist in the management of breathlessness Meeting with Community Partners, Bayshore Friday November 9 th, 2007 Cathy Kiteley Sharilee Cox-Arseneault Jennifer Parkins
2 Welcome and introductions Identification of the project Community engagement Review of dyspnea The nuts and bolts of the intervention Role play Moving the intervention into practice evaluation
3
4 Community nurse led breathlessness intervention In collaboration with the dyspnea management collaborative care plan as part of the Provincial Palliative Care Integration Project (PPCIP) Endorsed by LHIN 5&6 PPCIP Steering Committee
5 Best evidence Conceptual approach Proposed intervention Planned education Evaluation
6 Lung cancer is the most frequent diagnosed cancer overall in Ontario (Canadian Cancer Society, 2007) Dyspnea common symptom for individuals with metastatic disease (breast, colon, prostate) Cancer Care Ontario and PPCIP have identified dyspnea as a priority symptom
7 Nurses have good knowledge skill and judgment in symptom management. This project will articulate many of the interventions nurses are already using in their clinical practice and will incorporate best evidence.
8 Findings from chart review on 183 cancer patients first visit attending Credit Valley Hospital Palliative Care Clinic (C Kiteley, A Kurtz-Melo, 2006)
9 One years worth of data from the palliative care clinic analyzed. Here is what we found!!
10 Percentage Percentage LUNG NON-LUNG 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% % PPS PPS Average PPS Score: 57 Average PPS Score: 61 Total % with PPS 60 and below: Lung: 81% Non-Lung: 65%: * Statistically significant difference using chi-square analysis
11 Percentage Percentage LUNG Avg. # Symptoms: % had 6 or more symptoms rated 3 or greater 40% 35% 30% 25% 20% 15% 10% 5% 0% Number of Symptoms Rated Equal To or Above 3 NON-LUNG Avg. # Symptoms: % had 6 or more symptoms rated 3 or greater 40% 35% 30% 25% 20% 15% 10% 5% 0% Number of Symptoms Rated Equal To or Above 3 * Statistically significant difference using chi-square analysis
12 Symptom Lung (Severity) Non-Lung (Severity) Tiredness (Fatigue)** Appetite** Wellbeing Shortness of Breath* Drowsiness Pain Anxiety Depression Nausea * Statistically significant difference using t test ** Marginal significance
13 Two Randomized controlled studies are the foundation of the proposed nursing intervention Studies by Corner et al 1996 and Bredin et al 1999 Improved dyspnea rating Improved function Improved QOL
14 Another study by Hately et al (2003) replicated the nurse interventions in previous studies in a physio led clinic for breathlessness and found similar results
15 Conceptualization: A Parallel Model of Care Bio-medical model Pathophysiology Isolate cause Intervene Cure/remove sensation Therapeutic Relationship Active vs passive Controlling exclusive A Parallel model Mind + body Meaning Symptom redefined as problem Therapeutic relationship Partnership, reciprocity, mutual inquiry
16 For adult patients with lung cancer experiencing breathlessness receiving community home nursing: Detailed assessment of breathlessness Advice/support on ways to manage Therapeutic relationship exploring meaning Training on breathing exercises and relaxation Goal setting Early recognition of problems warranting pharmacological or medical intervention
17 Focus group to evaluate nurses experience with the intervention Aims of evaluation will be: Overall satisfaction and confidence in using intervention Evaluation of barriers or weaknesses with the program Perceived commitment by nurses Documentation challenges/issues
18 Bredin, M., Corner, J., Krishnasamy, M., Plant, H., Bailey, C., & A Hern, R. (1999). Multicentre randomised controlled trial of nursing intervention for breathlessness in patients with lung cancer. BMJ, 318, Corner, J., Plant, H., A Hern, R., & Bailey, C. (1996). Nonpharmacological intervention for breathlessness in lung cancer. Palliative Medicine, 10, Hately, J., Laurence, V., Scott, A., Baker, R., & Thomas, P. (2003). Breathlessness clinics within specialist palliative care settings can improve the quality of life and functional capacity of patients with lung cancer. Palliative Medicine, 17, Kitson, A., Harvey, G., & McCormack, B. (1998). Enabling the implementation of evidence based practice: a conceptual framework. Quality in Health Care, 7,
19 Logan, J., & Graham, I. (1998). Toward a comprehensive Interdisciplinary model of health care research use. Science Communication, 20(2), Registered Nurses Association of Ontario. (2002). Toolkit: Implementation of clinical practice guidelines. Toronto, Canada: Registered Nurses Association of Ontario.
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