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Mixed-methods feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (BREATHE): study findings

INTRODUCTION: One-fifth of emergency department presentations by ambulance are due to acute-on-chronic breathlessness. We explored the feasibility of an evaluation-phase, cluster randomised controlled trial (cRCT) of the effectiveness and cost-effectiveness of a paramedic-administered, non-pharmacol...

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Autores principales: Hutchinson, Ann, Allgar, Victoria, Cohen, Judith, Currow, David C., Griffin, Susan, Hart, Simon, Hird, Kelly, Hodge, Andrew, Mason, Suzanne, Northgraves, Matthew, Reeve, Joanne, Swan, Flavia, Johnson, Miriam J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: European Respiratory Society 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9677245/
https://www.ncbi.nlm.nih.gov/pubmed/36415651
http://dx.doi.org/10.1183/23120541.00257-2022
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author Hutchinson, Ann
Allgar, Victoria
Cohen, Judith
Currow, David C.
Griffin, Susan
Hart, Simon
Hird, Kelly
Hodge, Andrew
Mason, Suzanne
Northgraves, Matthew
Reeve, Joanne
Swan, Flavia
Johnson, Miriam J.
author_facet Hutchinson, Ann
Allgar, Victoria
Cohen, Judith
Currow, David C.
Griffin, Susan
Hart, Simon
Hird, Kelly
Hodge, Andrew
Mason, Suzanne
Northgraves, Matthew
Reeve, Joanne
Swan, Flavia
Johnson, Miriam J.
author_sort Hutchinson, Ann
collection PubMed
description INTRODUCTION: One-fifth of emergency department presentations by ambulance are due to acute-on-chronic breathlessness. We explored the feasibility of an evaluation-phase, cluster randomised controlled trial (cRCT) of the effectiveness and cost-effectiveness of a paramedic-administered, non-pharmacological breathlessness intervention for people with acute-on-chronic breathlessness at ambulance call-out (BREATHE) regarding breathlessness intensity and conveyance to hospital. METHODS: This mixed-methods, feasibility cRCT (ISRCTN80330546) randomised paramedics to usual care or intervention plus usual care. Retrospective patient consent to use call-out data (primary end-point) and prospective patient/carer consent for follow-up was sought. Potential primary outcomes included breathlessness intensity (numerical rating scale) and conveyance. Follow-up included: interviews with patients/carers and questionnaires at 14 days, 1 and 6 months; paramedic focus groups and surveys. RESULTS: Recruitment was during COVID-19, with high demands on paramedics and fewer call-outs by eligible patients. We enrolled 29 paramedics; nine withdrew. Randomisation/trial procedures were acceptable. Paramedics recruited 13 patients, not meeting recruitment target (n=36); eight patients and three carers were followed-up. Data quality was good but insufficient for future sample size estimation. The intervention did not extend call-out time, was delivered with fidelity and was acceptable to patients, carers and paramedics. There were no repeat call-outs within 48 h. All trained paramedics strongly recommended BREATHE as a highly relevant, simple intervention. CONCLUSION: Patient recruitment to target was not feasible during the pandemic. Training and intervention were acceptable and delivered with fidelity. Results include valuable information on recruitment, consent, attrition and data collection that will inform the design and delivery of a definitive trial.
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spelling pubmed-96772452022-11-21 Mixed-methods feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (BREATHE): study findings Hutchinson, Ann Allgar, Victoria Cohen, Judith Currow, David C. Griffin, Susan Hart, Simon Hird, Kelly Hodge, Andrew Mason, Suzanne Northgraves, Matthew Reeve, Joanne Swan, Flavia Johnson, Miriam J. ERJ Open Res Original Research Articles INTRODUCTION: One-fifth of emergency department presentations by ambulance are due to acute-on-chronic breathlessness. We explored the feasibility of an evaluation-phase, cluster randomised controlled trial (cRCT) of the effectiveness and cost-effectiveness of a paramedic-administered, non-pharmacological breathlessness intervention for people with acute-on-chronic breathlessness at ambulance call-out (BREATHE) regarding breathlessness intensity and conveyance to hospital. METHODS: This mixed-methods, feasibility cRCT (ISRCTN80330546) randomised paramedics to usual care or intervention plus usual care. Retrospective patient consent to use call-out data (primary end-point) and prospective patient/carer consent for follow-up was sought. Potential primary outcomes included breathlessness intensity (numerical rating scale) and conveyance. Follow-up included: interviews with patients/carers and questionnaires at 14 days, 1 and 6 months; paramedic focus groups and surveys. RESULTS: Recruitment was during COVID-19, with high demands on paramedics and fewer call-outs by eligible patients. We enrolled 29 paramedics; nine withdrew. Randomisation/trial procedures were acceptable. Paramedics recruited 13 patients, not meeting recruitment target (n=36); eight patients and three carers were followed-up. Data quality was good but insufficient for future sample size estimation. The intervention did not extend call-out time, was delivered with fidelity and was acceptable to patients, carers and paramedics. There were no repeat call-outs within 48 h. All trained paramedics strongly recommended BREATHE as a highly relevant, simple intervention. CONCLUSION: Patient recruitment to target was not feasible during the pandemic. Training and intervention were acceptable and delivered with fidelity. Results include valuable information on recruitment, consent, attrition and data collection that will inform the design and delivery of a definitive trial. European Respiratory Society 2022-11-21 /pmc/articles/PMC9677245/ /pubmed/36415651 http://dx.doi.org/10.1183/23120541.00257-2022 Text en Copyright ©The authors 2022 https://creativecommons.org/licenses/by-nc/4.0/This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org (mailto:permissions@ersnet.org)
spellingShingle Original Research Articles
Hutchinson, Ann
Allgar, Victoria
Cohen, Judith
Currow, David C.
Griffin, Susan
Hart, Simon
Hird, Kelly
Hodge, Andrew
Mason, Suzanne
Northgraves, Matthew
Reeve, Joanne
Swan, Flavia
Johnson, Miriam J.
Mixed-methods feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (BREATHE): study findings
title Mixed-methods feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (BREATHE): study findings
title_full Mixed-methods feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (BREATHE): study findings
title_fullStr Mixed-methods feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (BREATHE): study findings
title_full_unstemmed Mixed-methods feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (BREATHE): study findings
title_short Mixed-methods feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (BREATHE): study findings
title_sort mixed-methods feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (breathe): study findings
topic Original Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9677245/
https://www.ncbi.nlm.nih.gov/pubmed/36415651
http://dx.doi.org/10.1183/23120541.00257-2022
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