Quality statement 10	Palliative oxygen therapy (POT) can be considered as a trial for patients with hypoxaemia (saturations <92% on air) with refractory dyspnoea due to life-limiting disease that has not responded to opioids and non-pharmacological therapy, for example, fan therapy.
Rationale	Dyspnoea is a subjective experience and patients with hypoxaemia do not experience a significant difference in symptoms on air versus oxygen therapy. However, POT may be considered for patients with cancer or end-stage disease with limited prognosis (limited to weeks) who are hypoxaemic and are experiencing intractable breathlessness unresponsive to opioids or non-pharmacological therapies (eg, fan therapy).
Quality measure	Structure: Evidence of appropriate assessment of patients requiring POT. Evidence of trial of opioids when not contraindicated. Evidence of trial of non-pharmacological therapies. Process: The proportion of patients with intractable breathlessness on POT whose oxygen saturation is less than 92%. The proportion of patients on POT who are on opioids and non-pharmacological therapies. Numerator 1: The number of patients on POT whose oxygen saturation is less than 92%. Denominator 1: The number of patients on POT for intractable breathlessness.
	Numerator 2: The number of eligible patients on POT who have tried opioids and non-pharmacological therapies. Denominator 2: The number of patients on POT for intractable breathlessness.
Description of what the quality statement means for each audience	Service providers: Ensure systems are in place to disseminate guidelines in primary and secondary care. Ensure access to specialist palliative care team to help with assessment and management of intractable breathlessness. Ensure availability of oxygen practitioner to monitor appropriate and safe use of POT at home. Healthcare professionals: Ensure patient is on maximum treatment for underlying disease and reversible causes have been optimally treated where possible. Ensure oxygen saturation and severity of breathlessness are recorded as part of assessment of intractable breathlessness. Ensure POT is discontinued if not providing symptomatic benefit. Commissioners: Ensure sufficient staff in specialist palliative care and oxygen team are available to allow timely assessment of patients requiring POT in the community as well as hospital.
	People who require home oxygen: Patients and carers are offered written information about POT on discharge from hospital.
Relevant existing indicators/data sources	Local data collection/audit.
Source reference	BTS Home Oxygen Guideline for Home Oxygen Use in Adults 2015.3
Other information	Online Supplementary file 5, Assessment protocol for palliative oxygen—see BTS Guideline for Home Oxygen Use in Adults.3