Perspectives of primary care and community clinicians on chronic breathlessness management

Chronic breathlessness is common and requires specialised management. Primary and community care clinicians are well placed to care for people with breathlessness but desire additional resources and support to do so, as found in this qualitative study. Rationale Chronic breathlessness is a prevalent and debilitating symptom affecting people with chronic respiratory disease. However, community management of chronic breathlessness is limited. Further research is needed to determine how breathlessness care can best be delivered in primary care, identify knowledge and training gaps, and determine what resources might support such a model. This study explored the perspectives of Australian primary and community care clinicians regarding the management of chronic breathlessness, including barriers and facilitators to symptom-directed care. Methods Semi-structured interviews were conducted with clinicians from primary care and community settings within Australia. Data were analysed using a deductive thematic approach. Results Sixteen participants from diverse practice settings and roles were recruited from southern and eastern Australia. Five key themes emerged regarding community management of chronic breathlessness: invisibility; uncertainty, inflexibility and discomfort; roles and engagement with care; information and communication; and health systems and structures. Participants identified under-recognition, under-reporting, and inappropriate normalisation of breathlessness as barriers to management, and physical, diagnostic, and financial barriers that limited patient access to healthcare. Participants expressed interest in a targeted education program focusing on assessment and management of chronic breathlessness, and indicated a willingness to engage in such professional development opportunities. Conclusions Managing chronic breathlessness is a complex task, characterised by several patient-, clinician-, and system-related barriers that hinder effective clinical care. Primary care and community clinicians described significant challenges in managing chronic breathlessness, and desire education and support to better help people with this debilitating symptom. Grant support: NS is supported by an Australian Government NHMRC Investigator Grant.