Breathlessness training: comparison of two programmes for Shortness Of Breath in Lung Cancer

INTERVENTION: Low intensity training programme: Patients randomised to the low intensity arm will be taught four techniques of management of breathlessness at a single hour long session in a clinical setting appropriate to the needs of the patient by the therapist. They will be taught diaphragmatic breathing and pacing which require face‐to‐face demonstration. In addition, a brief introduction will be given to techniques to promote relaxation and manage anxiety. Written reinforcement in the form of information booklets plus verbal reinforcement in the format of the patients choice (tape, video or DVD) will be given to remind the patient of the techniques they have been taught. One week later, the therapist will ring the patient to see if they have remembered to practise the techniques and if they have managed to watch/listen to the reinforcement information. High intensity training programme: Patients randomised to the high intensity arm will be taught the same four techniques of the management of breathlessness at a hour long single session in a clinical setting appropriate to the needs of the patient by the therapist. This will be followed by practice and reinforcement face‐to‐face with the therapist on two further occasions at weekly intervals. Written reinforcement in the form of information booklets plus verbal reinforcement in the format of the patients choice (tape, video or DVD) will be given to remind the patient of the techniques they have been taught. One week after the final visit, the therapist will ring the patient to see if they have remembered to practise the techniques and if they have managed to watch/listen to the reinforcement information. CONDITION: Intrathoracic malignancy ; Cancer ; Malignant neoplasm of other and ill‐defined sites in the respiratory system and intrathoracic organs PRIMARY OUTCOME: Recruitment, retention and variability of breathlessness severity (Numerical Rating Scale [NRS] worst breathlessness over last 24 hours) SECONDARY OUTCOME: 1. NRS average breathlessness over last 24 hours; 2. NRS breathlessness "now" ; 3. NRS distress due to breathlessness ; 4. NRS coping with breathlessness; 5. NRS satisfaction of care; 6. Brief COPE; 7. Hospital Anxiety and Depression scale (HAD); 8. Euroqol EQ‐5D (EQ‐5D); 9. Visual Analogue Scale (VAS) INCLUSION CRITERIA: 1. Intractable breathlessness resulting from primary or secondary malignant lung disease in the palliative setting where the underlying cause has been maximally treated 2. All identified reversible causes of the breathlessness have been treated if appropriate to do so, in the opinion of the attending clinician 3. Karnofsky Performance Status (KPS) greater than 40% 4. Aged greater than 18 years, either sex 5. Willingness to attend for breathlessness training 6. Ability to give informed consent 7. Expected prognosis of at least 3 months in the opinion of the attending clinician