The Australian Capital Territory breathlessness intervention service (ABIS): a co-designed feasibility study

Breathlessness intervention services (BIS) coach people with chronic illness to self-manage persistent breathlessness using non-pharmacological strategies like positioning, breathing techniques and airflow. The Australian Capital Territory BIS (ABIS) Project aimed to co-design, implement and evaluate the feasibility of a home-based BIS delivered by a private physiotherapy provider. ABIS was evaluated against two goals: 1) 100 patients completing the program within 12 months; 2) ≥ 75% of patients reporting benefit on ≥ 1 outcome. ABIS and its evaluation framework were co-designed by persons with breathlessness, carers, clinicians and researchers. Patients were referred by GPs/medical specialists. Number of visits was tailored to patient/carer need. Evaluation used a mixed methods approach. Quantitative data consisted of process measures and clinical assessments double-purposed as outcome measures. Qualitative data included team meeting minutes and semi-structured interviews with patients, carers and referrers. The project team convened after 3-monthly plan-do-study-act (PDSA) cycles to review data and decide service refinements. Findings were integrated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) Framework. Reach: In the first 12 months, 64 patients completed the program, falling short of the 100 goal. Over 22 months, 140 patients completed ABIS (4% of the eligible population), including people who were older, less mobile and unable to access rehabilitation. Effectiveness: All patients reported improvements on ≥ 1 outcome: 90% on activities of daily living (ADLs), 70% ‘worst’ breathlessness, and 68% mastery. 21% reported having avoided calling an ambulance for breathlessness using the strategies they had learned through ABIS. As participants’ ADLs increased, breathlessness severity and mastery tended to worsen temporarily, with number of follow-ups being largely determined by how quickly mastery could be regained. 79% of carers reported improved confidence in supporting breathlessness. Adoption: GP engagement remained limited, with 47% referrals from specialist care. Implementation: The median number of visits was 4 (range 1–6). Mean cost per-patient was AUD1,576.86. Maintenance: Most patients maintained outcomes at 3/6-month follow-up. ABIS built system-level capacity for provision of ongoing breathlessness support after the project period. The ABIS Project offers new insights to inform community BIS design and adaptation. Future trials should compare cost-effectiveness of single- versus multi-disciplinary BIS.