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
Luckett, Tim; Roberts, Mary; Smith, Tracy; Garcia, Maja; Dunn, Sarah; Swan, Flavia; Ferguson, Caleb; Kochovska, Slavica; Phillips, Jane L.; Pearson, Mark; Currow, David C.; Johnson, Miriam J.
Dr Flavia Swan F.Swan@hull.ac.uk
Research fellow in cancer rehabilitation
Jane L. Phillips
Dr Mark Pearson Mark.Pearson@hull.ac.uk
Reader in Implementation Science
David C. Currow
Professor Miriam Johnson Miriam.Johnson@hull.ac.uk
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.
Luckett, T., Roberts, M., Smith, T., Garcia, M., Dunn, S., Swan, F., …Johnson, M. J. (2022). 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 Pulmonary Medicine, 22(1), Article 129. https://doi.org/10.1186/s12890-022-01925-z
|Journal Article Type||Article|
|Acceptance Date||Mar 25, 2022|
|Online Publication Date||Apr 6, 2022|
|Publication Date||Apr 6, 2022|
|Deposit Date||Apr 14, 2022|
|Publicly Available Date||Apr 14, 2022|
|Journal||BMC pulmonary medicine|
|Peer Reviewed||Peer Reviewed|
|Keywords||Breathlessness; COPD; Non-pharmacological management; Qualitative|
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© The Author(s) 2022. <br /> Open Access<br /> This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data
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