Development of a Brief Cognitive and Behavioral Intervention for the Management of Episodic Breathlessness—A Delphi Survey With International Experts

• Published in: Journal of pain and symptom management Vol. 61; no. 5; pp. 963 - 973.e1
• Main Authors: Schloesser, Karlotta, Eisenmann, Yvonne, Bergmann, Anja, Simon, Steffen T.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2021; Elsevier Limited
• Subjects: Behavior; Behavior modification; Breathlessness; Brief interventions; Caregivers; Cognitive development; Cognitive therapy; cognitive-behavioral; Cognitive-behavioral factors; Coping; Delphi; Disease management; Distraction; Dyspnea; episodic breathlessness; Experts; Nonpharmacological strategies; Polls & surveys; Relaxation; Relaxation training; Standardization; Delphi; episodic breathlessness; cognitive-behavioral
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2020.09.034

Episodic breathlessness is characterized by a severe worsening of breathlessness intensity that goes beyond usual fluctuations. Episodes are usually short; therefore, nonpharmacological strategies (cognitive and behavioral) seem most promising to be beneficial. Which strategies—delivered separately or in combination—might be most effective and feasible remains unclear. The Delphi survey selects and determines different nonpharmacological strategies for coping with episodic breathlessness to develop a brief cognitive and behavioral intervention for the management of episodic breathlessness. Using an online Delphi survey comprising three rounds, international, multidisciplinary experts in breathlessness summarized and determined cognitive and behavioral strategies. The a priori target agreement for close-ended questions was 70%. Experts (n = 41/87; n = 45/85; n = 36/85) agreed on 15 of the 31 cognitive and behavioral strategies. Based on the panellists' opinion, the final version of the cognitive and behavioral intervention comprised the following characteristics: individually tailored intervention, a high proportion of communication, short duration, the involvement of carers, and use of the Breathing, Thinking, Functioning Model of Spathis et al. Consensus upon the delivery of the subsequent strategies within the intervention was reached: handheld fan, forward lean, diaphragmatic breathing, distraction, pursed lips breathing, long breaths out, and relaxation training. Using the consented nonpharmacological strategies, a brief cognitive and behavioral intervention was developed that balances between individualization and standardization of the intervention.