Development of a brief cognitive and behavioural intervention for the management of episodic breathlessness - a Delphi survey with international experts.

Abstract Context Episodic breathlessness is characterized by a severe worsening of breathlessness intensity that goes beyond usual fluctuations. Episodes are usually short, therefore non-pharmacological strategies (cognitive and behavioural) seem most promising to be beneficial. Which strategies - delivered separately or in combination - might be most effective and feasible remains unclear. Objectives The Delphi survey selects and determines different non-pharmacological strategies for coping with episodic breathlessness to develop a brief cognitive and behavioural intervention for the management of episodic breathlessness. Methods Using an online Delphi survey comprising three rounds, international, multidisciplinary experts in breathlessness summarized and determined cognitive and behavioural strategies. The a priori target agreement for close-ended questions was 70%. Results Experts (n = 41/87; n = 45/85; n = 36/85) agreed on 15 of the 31 cognitive and behavioural strategies. Based on the panellists' opinion the final version of the cognitive and behavioural intervention composed the following characteristics: individually tailored intervention, a high proportion of communication, short duration, the involvement of carers, and use of the Breathing, Thinking, Functioning Model of Spathis et al.. Consensus upon the delivery of the subsequent strategies within the intervention was reached: handheld fan, forward lean, diaphragmatic breathing, distraction, pursed lips breathing, long breaths out and relaxation training. Conclusion Using the consented non-pharmacological strategies a brief cognitive and behavioural intervention was developed that balances between individualization and standardization of the intervention.