Table 1.
Details of Breathlessness Support Service
| Time | Type of contact with clinic | Content of meeting |
|---|---|---|
| Week 1 |
First outpatient clinic visit |
Contact with respiratory medicine |
| · explore the symptom of breathlessness and its triggers | ||
| · establish underlying cause of breathlessness | ||
| · optimise disease-orientated management | ||
| · review of previous investigations | ||
|
Contact with palliative medicine | ||
| · experience of breathlessness | ||
| · development of crises plan | ||
| · burden on patient & family | ||
| · symptom burden (other than breathlessness) | ||
| · psychosocial & spiritual issues | ||
| · introduction of non-pharmacological measures such as rollator and hand-held fan | ||
| Week 2 – 3 Week 2 - 3 |
Home visit Telephone call |
Based on the patients’ needs as assessed during home visit: |
|
Physiotherapy input | ||
| · review of the positions of breathlessness | ||
| · provision of a walking aid | ||
| · breathing control techniques and anxiety-panic cycle | ||
| · management of exacerbations in COPD | ||
| · home programme of exercise (DVD, personalised sheet) | ||
| · cough minimisation techniques | ||
| · pacing and fatigue management | ||
| · sputum clearance techniques | ||
| · ambulatory oxygen assessments | ||
| · referral to pulmonary rehabilitation | ||
|
Occupational therapy input | ||
| · assessment of ADL (mobility / transfers, self care and domestic ADL) | ||
| · assessment for aids and minor adoptions and referral for provision of equipment | ||
| · wheelchair prescription | ||
| · education on planning, pacing and energy conservation techniques to patients and carers | ||
| · referral to other community services (local / out of area), as appropriate | ||
| · assessment of need for social support and liaison with the BSS social worker, as appropriate | ||
| · liaison with the BSS team regarding interventions and feedback | ||
|
Social worker input | ||
| patient and or carer assessment including understanding of disease and symptoms & information needs and coping strategies | ||
| Week 4 - 5 |
second clinic visit |
Contact with palliative medicine |
| · re-evaluation of breathlessness and other symptoms | ||
| · checking of interventions | ||
| · referral to medical and/or palliative care services if appropriate | ||
| · discharge from service |