Schloesser Karlotta, Bergmann Anja, Eisenmann Yvonne, Pauli Berenike, Hellmich Martin, Oberste Max, Hamacher Stefanie, Tuchscherer Armin, Frank Konrad F, Randerath Winfried, Herkenrath Simon, Simon Steffen T
Department of Palliative Medicine, Faculty of Medicine and University Hospital (K.S., Y.E., B.P., S.T.S.), University of Cologne, Cologne, Germany.
Department of Nursing Science, Faculty of Medicine and University Hospital (A.B.), University of Cologne, Cologne, Germany.
J Pain Symptom Manage. 2022 May;63(5):758-768. doi: 10.1016/j.jpainsymman.2021.11.003. Epub 2021 Nov 15.
Episodic breathlessness is characterized by increased breathlessness intensity, and it is burdensome for patients. A vicious cycle of breathlessness-anxiety/panic-breathlessness leads to emergencies that can rarely be alleviated by drugs. Non-pharmacological interventions seem to be beneficial: Can a brief cognitive and behavioral intervention help patients to better manage episodic breathlessness?
To evaluate the feasibility, safety, acceptability, and potential effects of a brief cognitive and behavioral intervention for the management of episodic breathlessness.
Between February 2019 and February 2020, 49 patients with life-limiting diseases suffering from episodic breathlessness were enrolled in the single-arm phase II study. The baseline assessment was followed by the one- to two-hour intervention. In weeks two, four, and six after the intervention, the outcomes (main outcome of potential effects: mastery of breathlessness) were assessed, and in week six, a qualitative interview, and the final assessment took place. A mixed-methods approach was used to evaluate mainly the feasibility, including interviewing informal carers.
46/49 patients (24 female; 36 with COPD; mean age: 66.0 years) participated in the baseline assessment, 38 attended the intervention, 32 completed the final assessment, and 22 were interviewed. Study procedures and the intervention were feasible and mainly well accepted and patients did not experience burdens caused by it (28/32). In the interviews, patients described a positive change in their competencies in managing episodic breathlessness and feelings of anxiety during the episode. Mastery of breathlessness improved after the intervention.
The brief cognitive and behavioral intervention and the study procedures are feasible, safe, and well accepted. We can describe a change for better management of episodic breathlessness in patients after the intervention, still, this needs to be evaluated in a Phase III trial for inclusion in the management of episodic breathlessness.
发作性呼吸困难的特点是呼吸困难强度增加，对患者来说负担沉重。呼吸困难-焦虑/惊恐-呼吸困难的恶性循环会导致紧急情况，而药物治疗很少能缓解这些情况。非药物干预似乎有益：简短的认知和行为干预能否帮助患者更好地应对发作性呼吸困难？
评估一种简短的认知和行为干预对发作性呼吸困难管理的可行性、安全性、可接受性及潜在效果。
2019年2月至2020年2月期间，49例患有发作性呼吸困难的晚期疾病患者参加了单臂II期研究。在基线评估后进行1至2小时的干预。在干预后的第2周、第4周和第6周评估结果（潜在效果的主要结果：对呼吸困难的掌控），并在第6周进行定性访谈和最终评估。采用混合方法主要评估可行性，包括采访非正式护理人员。
46/49例患者（24例女性；36例慢性阻塞性肺疾病患者；平均年龄：66.0岁）参加了基线评估，38例接受了干预，32例完成了最终评估，22例接受了访谈。研究程序和干预措施可行，且主要被很好地接受，患者未经历由此带来的负担（28/32）。在访谈中，患者描述了他们在应对发作性呼吸困难和发作期间焦虑情绪的能力方面有积极变化。干预后对呼吸困难的掌控有所改善。
简短的认知和行为干预及研究程序可行、安全且被很好地接受。我们可以描述干预后患者在更好地管理发作性呼吸困难方面有变化，不过，这仍需在III期试验中进行评估，以纳入发作性呼吸困难的管理。
