181 Fans in practice: improving accessibility of handheld fans for palliative care inpatients suffering from breathlessness, at imperial college healthcare NHS trust

<h3>Background</h3> Refractory breathlessness is a common, distressing and neurally complex symptom.^{1 2 3} Much work has been done on the non pharmacological palliative treatment of breathlessness over the last twenty years^{4 5 6}: the use of fans has become well established⁷ and is now a first-line recommendation in the National Guidelines for Palliative Care.⁸ However, implementation is often limited by fan accessibility.^{9 10} <h3>Primary aim</h3> To improve accessibility of handheld fans for inpatients with breathlessness. <h3>Secondary aims</h3> To clarify some of the challenges in introducing a new treatment across interdisciplinary teams and different hospital sites. <h3>Methods</h3> Participants were adult inpatients with refractory breathlessness, for which they were receiving palliative treatment. Using funds from the Imperial Health Charity, participants were given handheld fans to use to help their breathlessness. They recorded Borg scores pre- and post-fan use and completed a short questionnaire. We completed 3 project cycles, expanding the project throughout the Trust. We started with patients referred to the palliative care team and later expanded the project to include patients under the respiratory team. We conducted quantitative and qualitative analysis of participant responses. <h3>Outcomes</h3> Over two hundred fans were sourced. Data were collected from 76 patients. 94% of patients found the fans helpful for their breathing. Qualitative feedback largely reflected patient satisfaction as well as comments on the fan quality. <h3>Conclusion</h3> Fans were found to be helpful by patients for management of their breathlessness and the majority of the patients did not have previous access to fans or the knowledge that fans could help their symptoms. Accessibility was therefore significantly improved in a cost-effective way. Data collection was challenging for a busy clinical team working across three sites, and suitable patients were more easily found in the respiratory wards. <h3>References</h3> Kathiresan G, Clement RF, Sankaranarayanan MT. Dyspnea in lung cancer patients: a systematic review. <i>Lung Cancer</i> 2010;<b>1</b>:141–150. doi: 10.2147/LCTT.S14426. Theander K, Hasselgren M, Luhr K, Eckerblad J, Unosson M, Karlsson I. Symptoms and impact of symptoms on function and health in patients with chronic obstructive pulmonary disease and chronic heart failure in primary health care. <i>Int J Chron Obstruct Pulmon Dis</i> 2014;<b>9</b>:785–94. doi: 10.2147/COPD.S62563. Stevens JP, Dechen T, Schwartzstein R, O’Donnell C, Baker K, Howell MD, Banzett RB. Prevalence of Dyspnea Among Hospitalized Patients at the Time of Admission. <i>J Pain Symptom Manage</i> 2018;<b>56</b>(1):15–22.e2. doi: 10.1016/j.jpainsymman.2018.02.013. Schwartzstein RM, Lahive K, Pope A, Weinberger SE, Weiss JW. Cold facial stimulation reduces breathlessness induced in normal subjects. <i>Am Rev Respir Dis</i> 1987;<b>136</b>(1):58–61. doi: 10.1164/ajrccm/136.1.58. Galbraith S, Fagan P, Perkins P, Lynch A, Booth S. Does the use of a handheld fan improve chronic dyspnea? A randomized, controlled, crossover trial. <i>J Pain Symptom Manage</i> 2010 ;<b>39</b>(5):831–8. doi: 10.1016/j.jpainsymman.2009.09.024. Spathis A, Booth S, Moffat C,<i> et al</i>. The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease. <i>Prim Care Resp Med</i> 2017;<b>27</b>:27. doi: 10.1038/s41533–017-0024-z. Sato T, Taito S, Nakashima Y, Sakai K, Kako J. Safety and Feasibility of Fan Therapy for Dyspnea: A Scoping Review. <i>Cureus</i> 2023;<b>15</b>(8):e43668. doi: 10.7759/cureus.43668. The Palliative Care Adult Network Guidelines, available from https://book.pallcare.info [accessed Thursday 16th May 2024] Brown J, Miller I, Barnes-Harris M, Johnson MJ, Pearson M, Luckett T, Swan F. The handheld fan for chronic breathlessness: Clinicians’ experiences and views of implementation in clinical practice. <i>PLoS One</i> 2023;<b>18</b>(11):e0294748. doi: 10.1371/journal.pone.0294748. PMID: 38015918. Luckett T, Roberts M, Smith T, Garcia M, Dunn S, Swan F, Ferguson C, Kochovska S, Phillips JL, Pearson M, Currow DC, Johnson MJ. Implementing the battery-operated hand-held fan as an evidence-based, non-pharmacological intervention for chronic breathlessness in patients with chronic obstructive pulmonary disease (COPD): a qualitative study of the views of specialist respiratory clinicians. <i>BMC Pulm Med</i> 2022;<b>22</b>(1):129. doi: 10.1186/s12890–022-01925-z.