Breathlessness discussions in oncology consultations: An exploratory quantitative analysis.

Abstract

Chronic breathlessness is a prevalent, distressing and debilitating symptom in people with life-limiting conditions, including cancer. Despite this, patients report that breathlessness is often ignored in routine clinical consultations. To explore whether breathlessness is discussed in oncology consultations and, if so, how it is assessed and managed. An exploratory sub-analysis of a mixed-methods study combining audio-recorded oncology consultations and post-consultation interviews with patients self-identifying breathlessness as concern (or not). Adults (≥18 years; any cancer/stage; able to provide informed consent and converse in English or with the help of an interpreter) in two hospitals' oncology outpatient clinics. Routine consultations (audio-recorded; transcribed; coded) and participant data (demographics; cancer type/stage; breathlessness; functional status; quality of life) are described. In 54 consultations with individual patients, seven (13%) patients (median age 74 [IQR 63-78]; male 71%; advanced cancer 100%) were concerned by breathlessness, a topic raised in 22/54 (41%) of consultations. In patients concerned about breathlessness, the symptom was raised in 5/7 (71%) consultations, mostly by patients (3/5;60%); however, it was not raised in the two patients with the most severe breathlessness (2/7;29%). In patients not concerned about breathlessness, the symptom was raised in 17/47 (36%) consultations, primarily by clinicians (14/17;82%). Breathlessness discussions focused on symptom history (5/5; 8/17), leading to no further action (3/5) nor specific outcomes (12/17). Chronic breathlessness was raised in less than half of the people with advanced cancers and not identified for those with the most severe breathlessness. Discussions offered no breathlessness-control advice.