None listed
Conditions
Brief summary
We are investigating a new educational strategy to support GPs in clinical decision making about dyspnoea (breathlessness) management in terminal cancer patients. Dyspnoea plagues patients with cancer at the end of life and management of breathlessness is a central challenge in the care of cancer patients. Effective strategies to translate known evidence into practice are needed. Most comprehensive educational programs are not useful in the real world because they are too complicated, time consuming or expensive. This educational program (academic detailing) is brief, easy to understand, based on the best evidence available and is acceptable to GPs. Academic detailing has a proven track record for improving patient-based outcomes by improving physician practice and patient personal care. This study aims to further our understanding of how academic detailing will work for cancer patients with breathlessness at the end of life. Findings from this study may provide us with information needed to undertake a larger definitive study that will include cancer patients at all stages of their illnesses. The ultimate goal of this pilot study is to improve the cancer patient’s breathlessness through the development of a comprehensive Randomised Clinical Trial (RCT) to determine the best method of initiating change in the primary care setting. Based on our findings, an implementation and training program could be developed which could be implemented nationally. Better management of dyspnoea has the potential to improve quality of life, reduce hospital admissions and reduce total cost.
Interventions
Academic detailing (an educational program) based upon the best available evidence, given to GPs by an experienced Respiratory and Palliative Care physician.The academic detailing is delivered face to face at a place and time suitable to the GP (usually at his/her surgery). There are 2 sessions, the first 2 weeks then 4 weeks after randomisation. The sessions last approximately 15-30 minutes.
The patient is not present at these sessions but is visited at home 3 times by the study nurse, at b
Academic detailing (an educational program) based upon the best available evidence, given to GPs by an experienced Respiratory and Palliative Care physician.The academic detailing is delivered face to face at a place and time suitable to the GP (usually at his/her surgery). There are 2 sessions, the first 2 weeks then 4 weeks after randomisation. The sessions last approximately 15-30 minutes. The patient is not present at these sessions but is visited at home 3 times by the study nurse, at baseline, week 6 and week 8. These visits last about 30 minutes and are at a time convenient to the patient. The information collected is about their general health, breathlessness and the medications they take. The detailing pertains specifically to their patient enrolled in the study but the topics cover 4 key messages. They are treatment of the underlying conditions contributing to their patients dyspnoea, which is assessed and amended if necessary. Examples of this may include management of pleural effusions, obstructions and anaemia. Pharmacological treatments: -Drug therapies can be varied but include oxygen and opioids. Non-pharmacological:- Complementary and alternative medical treatments such as visualisation, breathing training, time and pacing training can be included in some nurse led clinics or complementary therapy programmes. Pulmonary rehabilitation:- Referral to established programmes are appropriate in some circumstances and can overcome the barrier of GP time, while improving patient function. Duration of the intervention is approximately 8 weeks for the patient and 10 weeks for the GP.
Sponsors
Flinders University - Department of Palliative and Supportive Services
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Educational / counselling / training
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Moderate to severe dyspnoea (score of 3-5 on the modified MRC scale.) Referred to Southern Palliative Services (SAPS) with cancer. Within the geographic area visited by SAPS Community Palliative Care Nurses. All GPs of patients who consent to the study.
Exclusion criteria
Patients who are cognitively impaired Mini Mental Status Examination (MMSE) <24 . Patients who are dying at time of referral (expected death within 2 weeks) Patients who are referred to SAPS while hospital in-patients and are unlikely to be discharged( no further GP involvement). Patients who do not give consent or whose GP does not give consent.
Outcome results
None listed