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This is a protocol for a Cochrane Review Intervention. The objectives are as follows:. Breathlessness also termed dyspnea or shortness of breath is a prevalent clinical problem in cancer and a terrifying symptom for patients and their families Bruera ; Quast ; Reddy ; Tanaka ; Tishelman This is similar to prevalence rates reported for cancer patients in other studies Dudgeon This review focused solely on lung cancer and quality of life endpoints.
To date, none of the existing reviews of breathlessness interventions have specifically examined the effectiveness of self management interventions for breathlessness across a broad range of cancer patients and a detailed analysis of the intervention components or the characteristics of patients who benefited the most has not been examined. Self management interventions that emphasize behavioral change have shown potential in reducing breathlessness in other respiratory illnesses such as COPD Gadoury but the evidence for these approaches in reducing breathlessness in cancer patients is unclear.
Breathlessness is defined as "a subjective multidimensional experience of breathing discomfort that is comprised of qualitatively distinct sensations that vary in intensity" ATS Breathlessness is differentiated from objective measures of respiration, which include an increased respiratory and ventilatory rate and a reduction in oxygen saturation blood levels Ahmedzai The term breathlessness was coined as the lay term to capture the experience of dyspnea from the perspective of the patient O'Driscoll Breathlessness involves interactions among physiological, psychological, social and environmental factors that induce secondary physiological, emotional and behavioral responses Abernethy ; Dudgeon ; Howell ; Kathiresan ; Lansing ; O'Driscoll ; Von Leupoldt Self management is defined as, "the individual's ability to manage the symptoms, treatment regimes, physical and psychosocial consequences and lifestyle changes inherent in living with a chronic illness" Barlow Assuming daily self management involves assuming a new set of skills not in the patient's usual repertoire Holman and may be particularly complex in cancer as a result of multiple interacting symptoms and the overlay of psychosocial and existential distress Foster Self management programs are more than patient education and efforts to improve health by changing knowledge alone have minimal effects Bourbeau ; Warsi Self management interventions target behavioral change through promoting skills and confidence self efficacy in management of symptoms i.
Despite advances in the treatment of cancer over the past decade, the management of complex cancer symptoms like breathlessness remains a concern for both clinicians and patients Booth ; Booth Effective management of symptoms such as breathlessness is characterized by extensive responsibility that patients must take to self manage the symptom, including adhering to medication, making lifestyle changes, coping with stress and emotions, and taking preventive actions.
Self management interventions have shown beneficial effects in reducing breathlessness in COPD Nguyen ; Nguyen and in reducing hospital admissions and overall health care use Effing ; Gadoury However, uncertainty remains about whether self management interventions are beneficial for complex cancer symptoms such as breathlessness and there is a lack of clarity regarding the components and delivery approaches that are most beneficial in achieving an effect.