OP08 A feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (BREATHE): study findings

Hutchinson, A; Allgar, V; Cohen, J; Currow, D; Griffin, S; Hart, S; Hodge, A; Mason, S; Northgraves, M; Reeve, J; Swan, F; Johnson, M

OP08 A feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (BREATHE): study findings

Hutchinson, A Allgar, V Cohen, J Currow, D

Griffin, S Hart, S Hodge, A Mason, S Northgraves, M Reeve, J Swan, F Johnson, M

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Publisher:: BMJ
Publication Type:: Journal Article
Citation:: Emergency Medicine Journal, 2022, 39, (9), pp. e5.45
Issue Date:: 2022-09

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Field	Value	Language
dc.contributor.author	Hutchinson, A
dc.contributor.author	Allgar, V
dc.contributor.author	Cohen, J
dc.contributor.author	Currow, D https://orcid.org/0000-0003-1988-1250
dc.contributor.author	Griffin, S
dc.contributor.author	Hart, S
dc.contributor.author	Hodge, A
dc.contributor.author	Mason, S
dc.contributor.author	Northgraves, M
dc.contributor.author	Reeve, J
dc.contributor.author	Swan, F
dc.contributor.author	Johnson, M
dc.date.accessioned	2023-02-02T00:40:43Z
dc.date.available	2023-02-02T00:40:43Z
dc.date.issued	2022-09
dc.identifier.citation	Emergency Medicine Journal, 2022, 39, (9), pp. e5.45
dc.identifier.issn	1472-0205
dc.identifier.issn	1472-0213
dc.identifier.uri	http://hdl.handle.net/10453/165820
dc.description.abstract	<jats:sec><jats:title>Background</jats:title><jats:p>One-fifth of conveyances to the emergency department (ED) are due to acute-on-chronic breathlessness. Paramedic breathlessness management may ease distress quicker and/or reduce ED conveyances. We evaluated the feasibility of a full trial of a paramedic delivered intervention to reduce avoidable conveyances (recruitment, randomisation, consent, training and intervention acceptability, adherence, data quality, best primary outcome, sample size estimation). The intervention comprised evidence-based non-drug techniques and a self-management booklet.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This mixed-methods feasibility cluster randomised controlled trial (<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="isrctn" xlink:href="80330546">ISRCTN80330546</jats:ext-link>) with embedded qualitative study about trial processes, training and intervention delivery, randomised paramedics to usual care or to intervention+usual care. Retrospective patient consent to use call-out data and prospective patient/carer consent for follow-up was sought. Potential primary outcomes were breathlessness intensity (numerical rating scale) and ED conveyance. Follow-up included an interview for patients/carers and questionnaires at 14 days, 1 and 6 months and paramedic focus groups and survey.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Recruitment was during the COVID-19 pandemic, leading to high demands on paramedics and fewer call-outs by eligible patients. We enrolled 29 paramedics; 9 withdrew. Randomisation/trial procedures were acceptable. Paramedics recruited 13 patients; 8 were followed up. Data quality was good. The intervention did not extend call-out time, was delivered with fidelity and no contamination and was acceptable to patients, carers, and paramedics. There were no repeat call-outs < 48 hours. Recruitment stop-go criteria were not met. We had insufficient data for sample size estimation.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>A full trial in the <jats:underline>same</jats:underline> circumstances is not feasible. However, valuable information was gained on recruitment, attrition, consent, training and intervention acceptability and adherence, and patient-reported data collection.</jats:p></jats:sec>
dc.language	en
dc.publisher	BMJ
dc.relation.ispartof	Emergency Medicine Journal
dc.relation.isbasedon	10.1136/emermed-2022-999.8
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1103 Clinical Sciences, 1110 Nursing, 1117 Public Health and Health Services
dc.subject.classification	Emergency & Critical Care Medicine
dc.title	OP08 A feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (BREATHE): study findings
dc.type	Journal Article
utslib.citation.volume	39
utslib.for	1103 Clinical Sciences
utslib.for	1110 Nursing
utslib.for	1117 Public Health and Health Services
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	closed_access	*
dc.date.updated	2023-02-02T00:40:42Z
pubs.issue	9
pubs.publication-status	Published
pubs.volume	39
utslib.citation.issue	9

Abstract:

BackgroundOne-fifth of conveyances to the emergency department (ED) are due to acute-on-chronic breathlessness. Paramedic breathlessness management may ease distress quicker and/or reduce ED conveyances. We evaluated the feasibility of a full trial of a paramedic delivered intervention to reduce avoidable conveyances (recruitment, randomisation, consent, training and intervention acceptability, adherence, data quality, best primary outcome, sample size estimation). The intervention comprised evidence-based non-drug techniques and a self-management booklet.MethodsThis mixed-methods feasibility cluster randomised controlled trial (ISRCTN80330546) with embedded qualitative study about trial processes, training and intervention delivery, randomised paramedics to usual care or to intervention+usual care. Retrospective patient consent to use call-out data and prospective patient/carer consent for follow-up was sought. Potential primary outcomes were breathlessness intensity (numerical rating scale) and ED conveyance. Follow-up included an interview for patients/carers and questionnaires at 14 days, 1 and 6 months and paramedic focus groups and survey.ResultsRecruitment was during the COVID-19 pandemic, leading to high demands on paramedics and fewer call-outs by eligible patients. We enrolled 29 paramedics; 9 withdrew. Randomisation/trial procedures were acceptable. Paramedics recruited 13 patients; 8 were followed up. Data quality was good. The intervention did not extend call-out time, was delivered with fidelity and no contamination and was acceptable to patients, carers, and paramedics. There were no repeat call-outs < 48 hours. Recruitment stop-go criteria were not met. We had insufficient data for sample size estimation.ConclusionsA full trial in the same circumstances is not feasible. However, valuable information was gained on recruitment, attrition, consent, training and intervention acceptability and adherence, and patient-reported data collection.

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http://hdl.handle.net/10453/165820