Symptom-based pathways to earlier diagnosis: how to improve health for sufferers of chronic breathlessness with a cost-effective approach.
Description: Becoming short of breath doing everyday activities is a common problem. People often see their General Practitioner (GP). It can be difficult for a GP to know whether there is a serious problem and what the problem is. There are many reasons why people become more short of breath. Over half of cases are caused by five problems: a heart condition called 'Chronic Heart Failure (CHF)' a lung condition called 'Chronic Obstructive Pulmonary Disease (COPD)' obesity (being very overweight) anaemia (low red blood cells that carry oxygen around the body) anxiety We know many people wait a long time to find out what the problem is and to get the right treatment. In part because guidelines for GPs focus on specific diseases and specialist services are designed around 'specialities' such as cardiology (specialist heart services) not symptoms. Specialist exercise programmes are available for people with more severe heart and lung problems to improve shortness of breath. These programmes are known to be good for patients and improve their quality of life. Patients tell us they wish they had received this treatment earlier. This research involves people older than forty years old who go to their GP as they are becoming short of breath, and aims to: 1) Investigate their long term quality of life and how long they live. 2) Understand what features of becoming short of breath such as being less active affect their long term health. 3) Design a research trial to compare whether GPs using more investigations (focusing on the five common causes) early will lead to an earlier diagnosis and what this costs. 4) Understand whether combining an intervention to achieve an earlier diagnosis with earlier support to lead a healthy lifestyle would help prevent the longer term effects of being breathless and improve health To answer Questions 1 and 2 would need a large study of a group monitored yearly for a few years. Questions 3 and 4 need a large, expensive study to answer them. The aims of the fellowship are to conduct two smaller studies: the first to answer aspects of the first two questions using a measure of the risk of developing heart disease or diabetes as a surrogate of death rate. With this information, funding will be applied for to continue the study for longer to answer the questions completely. GPs will then have more information to discuss with a breathless person which could alter what treatment they receive and help them lead a more healthy life. The second study is to see whether and how the larger expensive study can be performed. Design and method In people older than forty years old who go to their GP as they are becoming short of breath doing everyday things for over two months: 1) A study will be undertaken where they are monitored at the beginning and end of one year. It will investigate how features caused by being short of breath influence their risk of heart disease and diabetes in future. 2) A study will be undertaken to see whether the larger study is practical. GP practices either continue usual care for these individuals (organising tests as they see fit) or to perform multiple specified tests straight away. Each practice will be allocated to one of these groups at random. Patients and GPs will be interviewed to understand their experience to inform the next trial. The main outcome will be how many patients can be recruited to the study in six months and to understand how many GP practices would be needed for the main trial. Whether the different parts of the study work together, whether having multiple tests was acceptable to patients, and whether patients would be willing to accept support to lead a healthier lifestyle will all be explored. Patient and Public Involvement The idea for this research came from patients with shortness of breath requesting earlier diagnosis and treatments. I have worked with patients to develop the research proposal and patients will be key members of the research steering group throughout the studies. Dissemination The information from the studies will be reported in different ways for peer reviewed journals, the relevant voluntary group sector, and patients. A film of how patient involvement shaped the research throughout will be made.
Amount: £1,023,000
Funding type: fellowship
Funder scheme: NIHR Fellowships
Start date: 2017-03-01
End date: 2022-08-31
Investigator: Rachael Evans
Institution: University of Leicester
Funded outputs count: 67
Funder award ID: CS-2016-16-020
OpenAlex ID: G1011640197