Fatigue, Anxiety and Breathless Programme
F.A.B
Rationale:A multi disciplinary team from Birmingham Community Healthcare NHS Trust
(BCHC) and John Taylor Hospice have worked closely together with Chronic
Obstructive Pulmonary Disease (COPD) patients to improve their: well being; self
management techniques; and knowledge of their condition whilst offering support to
their carers. This was delivered by a Respiratory Nurse Specialist (BCHC), a
Psychologist, an Occupational Therapist, a Physiotherapist from John Taylor Hospice
who lead the initiative, with occasional input from other healthcare professionals such
as Pharmacist, Dietician and Social Worker. The 10 week programme consists of 2
hour sessions which cover a variety of topics including: updates regarding their
disease; educational sessions; graded seated exercise and relaxation techniques.
The pilot Fatigue Anxiety and Breathlessness (FAB) management programme
carried out in October 2010 aimed to develop the confidence of the participants’, and
their carers, to self-manage their condition. The self management technique was
based on cognitive-behavioural psychology (CBT) changing the healthcare
professionals roles from that of therapist to enablers, trainers and coaches. The
model used is known as the Bio psychosocial model of health and is used for Long
Term Conditions. The model acknowledges that multiple components (physical,
emotional, psychological and social) are linked in a reciprocal fashion, often feeding
one another in a circular fashion. It doesn’t attempt to identify cause of health
conditions, but provides a useful starting point for a self-management approach.
Assisting people to see how factors such as stress and emotions can connect with
their physical symptoms and how working on skills such as pacing and relaxation
affects their health.
The Pilot Project
14 patients were assessed for the programme but only 9 patients participated. The
aims of the programme were:
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Gaining an understanding of participants (and carers) thoughts and beliefs
about their condition(s)
Provide appropriate information about their condition(s) to help develop their
understanding and beliefs
Help participants to challenge unhelpful beliefs about their condition(s)
Coaching in coping skills such as pacing, energy conservation and
communication
Help change participants’ views of their problems from overwhelming to
manageable
Provide feedback to change their views of themselves from: passive, reactive
and helpless, to active resourceful and competent
Help participants anticipate future problems
Prior to starting the programme, the Respiratory Nurse Specialist used pre
measurements alongside a holistic COPD review of the patient to ensure on
maximal therapy. On completion of the 10 weeks programme the measurements
were repeated.
The measurements included:
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Modified Borg Scale (scale of 0-10 for patients perceived breathlessness
at rest and on exertion).
COPD Assessment Tool (CAT) (patient’s perspective which indicates how
well people are managing their condition).
The patient’s concerns checklist (thermometer) which is adapted from
pan-Birmingham NHS Cancer Network/Cancer psychology Services
(used to highlight any issues that may be adding to their anxiety/stress).
On completion of the programme an evaluation/questionnaire form was
completed and audited along with the Pre and Post measurements.
Example of pre programme scores: Patient no 9
Modified Breathless Score – 2 at rest and 3 on exertion
CAT score - 21
Hospital attendances/admissions in previous year - 16
Post programme Scores: Patient no 9
Modified Breathless Score – 0 at rest and 0 on exertion
CAT score – 15
Hospital attendances/admissions in prior year - 6
Patients who completed the formal evaluation said that the programme had
definitely been of benefit, finding the group work more productive than one to one
sessions. Participants were inspired by their other attendees, improving
motivation and social allegiance.
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A couple of patient quotes were:“I felt it helped and was useful, I would recommend it to others”
“I didn’t realise how much I was able to achieve and (the course) provided
a different perspective in life”
“I was finally able to gain confidence
“I finally found the courage to have dental treatment that was required
which I had put off for so long due to my fear of breathlessness and
anxiety during having treatment”.
Staffs comments were:“Participating in the pilot programme enhanced my teaching skills and enabled
me to see how a group session can be run effectively. I learned new techniques
such as breathing and relaxation and working with colleagues updated my
knowledge of symptom control”
Since the initial pilot was completed in 2011 there have been a further four
programmes completed in 2012, with another 3 scheduled for January and May
and October 2013. Review discussions are to be held regarding continuation and
expansion of the programme.
Deborah Edmunds (Respiratory Nurse Specialist) contact number 0121 465 2692