BTS guideline for the investigation and management of malignant pleural mesothelioma.

The full guideline for the investigation and management of malignant pleural mesothelioma is published in Thorax. The following is a summary of the recommendations and good practice points. The sections referred to in the summary refer to the full guideline.

Excellence in cost-effective inpatient specialist palliative care in the NHS - a new model.

There is little in the literature describing hospital specialist palliative care units (PCUs) within the NHS. This paper describes how specialist PCUs can be set up within and be entirely funded by the NHS, and outlines some of the challenges and successes of the units. Having PCUs within hospitals has offered patients increased choice over their place of care and death; perhaps not surprisingly leading to a reduced death rate in the acute hospital. However, since the opening of the PCUs there has also been an increased home death rate. The PCUs are well received by patients, families and other staff within the hospital. We believe they offer a model for excellence in cost-effective inpatient specialist palliative care within the NHS.

Individual experiences and impacts of a physiotherapist-led, non-pharmacological breathlessness programme for patients with intrathoracic malignancy: a qualitative study.

BACKGROUND: Non-pharmacological breathlessness management programmes have been shown to be beneficial in the management of lung cancer-related dyspnoea for more than 10 years. What is not so clear is how they work. AIM: To evaluate how patients with intrathoracic malignancy (lung cancer or pleural mesothelioma) undergoing the non-pharmacological breathlessness management programmes benefited from the programme, using a qualitative methodology. DESIGN AND SETTING: Consecutive patients completing the programme were invited to be interviewed (semi-structured and audio-recorded) about their experiences of the programme, what had helped them and how. Interviews were transcribed and analysed using interpretative phenomenological analysis. RESULTS: Nine patients were interviewed. Seven major themes emerged, they are summarised as follows: (1) Mixed prior expectations of the programme, (2) flexibility of delivery and additional support needs, (3) physiotherapist attributes and skills in developing an effective helping relationship, (4) adoption of new techniques, (5) the effects and impact of the programme and new techniques, (6) difficulties and barriers to achieving change and (7) facing an uncertain future beyond the programme. CONCLUSION: The non-pharmacological breathlessness management programme appears to offer a wide range of benefits to patients, including improving functional capacity, coping strategies and self-control. Such benefits are most likely to be due to a combination of breathing control, activity management and the therapist qualities.

An evaluation of a physiotherapy led non-pharmacological breathlessness programme for patients with intrathoracic malignancy.

The outcomes of the first 4 years of a physiotherapy led non-pharmacological breathlessness management programme for patients with intrathoracic malignancy are described. Of the 169 patients enrolling, only 14 completed the full 4-week programme. All reported improvements in some parameters measured though these did not reach statistical significance. These patients tended to be fitter, had longer median survival and the mechanism of their breathlessness was not progressive cancer. The 155 patients who did not complete the programme had a short median survival (95 days), and tended to have cancer related breathlessness. Of these, 131 were seen, 85 receiving part of the programme, 15 needing other services and 31 started but died during the programme. Objective post intervention scores could not be made in this group, but anecdotal quotes suggested benefit. In a group whose natural history is a relentless deterioration over a period of months, pre- and post-intervention symptom scoring is difficult to achieve. It is suggested that a qualitative approach might be more sensitive at identifying which aspects of the service are most appropriate.