Considerations in developing and delivering a non-pharmacological intervention for symptom management in lung cancer: the views of health care professionals

Background A respiratory distress symptom cluster hasrecently been identified in lung cancer associated with breathlessness,cough and fatigue, and the study reported here is partof a wider body of work being undertaken to develop a novel non-pharmacological intervention (NPI) for the management of this symptomcluster. The current paper reports the views of health care professionals (HCPs) involved with cancer care regarding the most appropriate ways of developing and delivering such a novel intervention.Methods Five focus groups, supplemented with additionaltelephone interviews, were conducted with a range of bothcommunity- and acute-based HCPs involved in symptommanagement for lung cancer patients. Participants includedoncologists, palliative care consultants, specialist nurses,occupational therapists and physiotherapists. The focusgroups were transcribed verbatim and analysed using NVIVOto support a framework analysis approach.Results The current delivery of NPIs was found to be ad hocand varied between sites both in terms of what was deliveredand by which health care professionals. The provision ofNPIs within acute medical settings faced common problemsconcerning staffing time and space, and there was a recognition that the preference of most patients to make as few hospital visits as possible also complicated NPI teaching. Moreover, there may only be a small window of opportunity in which to effectively teach lung cancer patients a novel NPI as the period between diagnosis and the onset of severe symptoms is often short.Discussion The participants agreed that the novel symptommanagement NPI should be individually personalised to theneeds of each patient and be available for patients when they become receptive to it. Moreover, they agreed that theintervention would be most effective if delivered to patients individually rather than in groups, outside acute medicalsettings where possible and closer to patient’s homes, should be delivered by an HCP rather than a trained volunteer or lay person and should involve informal carers wherever practicable