title: Service delivery of complex interventions for refractory breathlessness.
abstract: The review considers the evidence for different service models existing for helping people manage the chronic, irreversible breathlessness that accompanies advanced disease.
  
  
  
  Many of the service models that are delivering care have not yet published their results in the scientific literature because these ideas, and the methods to evaluate them, are relatively new. There are three randomized controlled trials published which demonstrate the effectiveness of this approach and one which suggests that more episodes of some intervention components are not necessarily better.
  
  
  
  Breathlessness severity gives a better guide to a patient's prognosis than physiological measures in many diseases and the general population. Randomized controlled trial evidence confirms that a complex intervention for breathlessness can improve quality of life, reduce symptom impact, and support carers. Some preliminary data suggest prognosis improvement in some people. Integrated care is needed for both rapidly progressive disease, where death is inevitable, and chronic illness, when health improvement is possible.
authors.affiliation: aCambridge Breathlessness Intervention Service (CBIS), University of Cambridge bDepartment of Primary Care, Cambridge Institute of Public Health cCBIS, CUHNHSFT, Cambridge, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: Booth
authors.forename: Richella
authors.initials: R
authors.lastname: Ryan
authors.forename: Anna
authors.initials: A
authors.lastname: Spathis
mesh_terms: D017028:Caregivers / Q000523:psychology; D002908:Chronic Disease; D004417:Dyspnea / Q000523:psychology / Q000628:therapy*; D006801:Humans; D010166:Palliative Care / Q000458:organization & administration*; D010346:Patient Care Management / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D011379:Prognosis; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index