Ms Roslyn Kirk1, Ms Marina Siemionow2, Ms Pamela Harris2, Mr Klaus Inveen2, Mr David Reid2, Ms Mary Roberts3, Dr Domenica Disalvo4, Mr Simon Kragh5, Ms Jeanelle van Zyl5, Ms Casey van Rooy5, Ms Mirei Churton1, Associate Professor Tim Luckett4
1Capital Health Network – ACT PHN, Canberra, Australia, 2Consumer Representatives, Canberra, Australia, 3Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, Australia, 4IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney (UTS), Sydney, Australia, 5Southside Physio Group, Tuggeranong, Australia
Biography:
Ros is a registered nurse and has over 20 years of experience working in specialist palliative care and is currently the Palliative Planning Manager for the PHN, Capital Health Network where she is responsible for the planning, development and implementation of the Greater Choice for At Home Palliative Care measure funded by the Department of Health and Aged Care.
Ros is also a trained in Clinical Supervisor and provides clinical supervision for frontline healthcare workers across the ACT who care for patients and their families at end-of-life.
Abstract:
Background: A breathlessness intervention service for the ACT (ABIS) and evaluation framework were co-designed and piloted from March 2023. Patients were eligible if they had modified Medical Research Council (mMRC) ≥2. Referrals were invited from general practice and one respiratory service. Patients and carers received an initial assessment by a physiotherapist at home, with up to 6 follow-ups determined by patient need. Physiotherapists took a person-centred coaching approach and provided education on non-pharmacological management, exercise and other lifestyle factors.
Aim: To appraise ABIS’s feasibility and impact on patient and carer outcomes.
Methods: A quality improvement approach was taken using plan-do-study-act (PDSA) cycles. The project’s SMART goal was 100 patients completing ABIS within 12-months, with at least 75% reporting clinically important benefits on one or more outcome as follows: activities of daily living (ADL) selected by each patient, breathlessness mastery and severity of worst breathlessness. Self-reported ambulance avoidance and carer confidence were also measured. Semi-structured interviews were conducted with patients/carers via phone to canvass their perceptions of the service.
Results: By the end of 2023, 41 patients had completed ABIS with 23 more continuing to receive follow-ups. The median number of follow-ups was four (inter-quartile range, 2). All patients completing ABIS achieved improvement on at least one outcome measure: 39 (95%) on ≥1 ADL, 31 (76%) on mastery and 26 (63%) on worst breathlessness. Fourteen (34%) patients reported thinking about calling an ambulance on 22 occasions but self-managing instead. 25/38 (67%) carers reported improvements in confidence. 10 patients and 2 carers agreed to interviews, praising person-centred and home-based features of the service.
Conclusions: This pre/post evaluation adds to evidence that BISs improve patient and carer outcomes across health conditions. The main challenge to feasibility has been maintaining sufficient referrals from general practice.