187 Identification and assessment of breathlessness in clinical practice: a systematic review and narrative synthesis

Background Breathlessness is common in chronic conditions but often goes unidentified by clinicians. It is important to understand how identification and assessment of breathlessness occurs across healthcare settings, to promote routine outcome assessment and access to treatment. Objective To summarise how breathlessness is identified and assessed in adults with chronic conditions across different healthcare settings. Methods This is a systematic review and descriptive narrative synthesis (PROSPERO registration: CRD42018089782). Searches were conducted on Medline, PsycINFO, Cochrane Library, Embase and CINAHL (2000–2018) and reference lists. Screening was conducted by two independent reviewers, with access to a third, against inclusion criteria. Data were extracted using a bespoke proforma. Results Ninety-seven studies were included; conducted in primary care (n=9), secondary care (n=53) and specialist palliative care (n=35). Twenty-five measures of identification and 41 measures of assessment of breathlessness were used. Primary and secondary care used a range of measures to assess breathlessness severity, cause, and impact for people with chronic obstructive pulmonary disease (COPD). Specialist palliative care used measures assessing broader symptom severity and function with less focus on overall quality of life (QoL). Few studies were identified from primary care. Conclusion Various measures were identified, reflective of the setting’s purpose. However, this highlights missed opportunities for breathlessness management across settings; primary care is particularly well-placed to diagnose and support breathlessness. The COPD approach (where symptoms and QoL are part of disease management) could apply to other conditions. Better documentation of holistic patient-reported measures may drive service improvement in specialist palliative care.