{"entity":{"id":"idea-pu-breath-hold-coaching-before-planning","kind":"idea","name":"Breath-hold coaching and home practice a week before the planning scan, in the patient's own language","aka":[],"tldr":"Breath-hold is usually taught on the day of the planning scan. Two hospital series found that teaching it at least five days earlier, with practice at home, went with lower heart doses and shorter set-up times, and a survey of American radiation oncologists found interpreters were present at fewer than one in three first treatments for people who do not speak English.","summary":"The practice. Holding a deep breath with the chest rather than the belly, at the same depth, for up to 40 seconds, is not intuitive. The usual approach is to teach it at the planning CT scan. The upgrade is to teach it earlier, give written instructions, and ask the patient to practise.\n\nWhat the series found. At one centre, 27 women coached by one physician at least five days before their planning scan, with home practice, were compared with 42 who were not coached, under another physician. The maximum heart dose in breath-hold was 13.1 Gy with coaching against 19.4 Gy without (p equals 0.004), and the percentage of heart receiving 10 Gy was 0.1 against 0.5 per cent (p equals 0.005). In a second series, 36 women coached by a nurse with an instruction sheet at least a week before planning were compared with 28 taught only on the day: set-up was shorter in more than half of treatment sessions and the maximum dose to the left anterior descending coronary artery was lower. Both studies are retrospective comparisons between groups treated by different teams, the authors of the first call their findings hypothesis-generating, and the coached group in the second series was older and heavier than the uncoached one. That is why the grade here is insufficient: the direction is consistent, and nobody has randomised it.\n\nLanguage. In a 2022 survey of 53 United States radiation oncologists, 98 per cent of those using breath-hold coached it at the planning scan, but an interpreter was present 76 to 100 per cent of the time at simulation for 51 per cent of respondents, falling to 31 per cent at the first treatment and 11 per cent at later treatments. Without an interpreter, 55 per cent coached in English and 11 per cent used visual aids; 32 per cent said they would be less likely to offer breath-hold to a non-English speaker. Coaching material in the patient's own language, and pictures or a visual feedback screen that need no language at all, address both problems at once.\n\nAdoption of early coaching is not measured by any source OnCo found.","asOf":"2026-10-20","links":[{"label":"Kim et al., Effects of preparatory coaching and home practice for deep inspiration breath hold on cardiac dose for left breast radiation therapy (Clinical Oncology 2018)","url":"https://doi.org/10.1016/j.clon.2018.04.009"},{"label":"Kefeli et al., Patient coaching for deep inspiration breath hold decreases set-up duration and left anterior descending artery dose for left-sided breast cancer radiotherapy (Supportive Care in Cancer 2025)","url":"https://doi.org/10.1007/s00520-025-09446-1"},{"label":"Shukla et al., Disparities in radiation therapy: practice patterns analysis of deep inspiratory breath hold use in non-English speakers (International Journal of Radiation Oncology, Biology, Physics 2022)","url":"https://doi.org/10.1016/j.ijrobp.2021.12.171"}],"tags":["protocol-upgrade","upgrade:promising","evidence:insufficient","precision","breast"],"related":["idea-pu-breath-hold-left-breast-routine","idea-pu-breath-hold-visual-feedback"],"cancers":["breast-cancer"],"sections":["radiation"],"technologies":["respiratory-motion-management"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["deep-inspiration-breath-hold"],"trials":[],"people":[],"bottlenecks":["b-toxicity-qol","b-patient-voice"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Structured breath-hold coaching at least five days before the planning scan, with home practice and materials in the patient's own language, lowers mean heart dose and set-up time compared with teaching on the day, and narrows the gap in breath-hold use between people who do and do not speak the clinic's language.","rationale":"Two independent series in different countries point the same way, the intervention is a leaflet, a video and a nurse appointment, and the measured gap in interpreter presence at treatment makes the language component a fairness question as well as a dosimetric one.","test":"A randomised trial of early coaching with home practice against same-day teaching in left-sided breast radiotherapy, stratified by preferred language, with mean heart dose and breath-hold eligibility as co-primary endpoints and set-up time as secondary.","maturity":"early-clinical","actor":"clinic","cost":"small","horizonYears":2},"route":"/ideas/idea-pu-breath-hold-coaching-before-planning/","neighbours":{"idea":[{"id":"idea-pu-breath-hold-left-breast-routine","kind":"idea","name":"Deep-breath-hold radiotherapy for every suitable person with left-sided breast cancer","route":"/ideas/idea-pu-breath-hold-left-breast-routine/"},{"id":"idea-pu-breath-hold-visual-feedback","kind":"idea","name":"Let the patient see their own breath-hold on a screen or in video glasses","route":"/ideas/idea-pu-breath-hold-visual-feedback/"},{"id":"idea-pu-radiotherapy-walkthrough-before-planning","kind":"idea","name":"Show people the radiotherapy room and the treatment before the planning appointment, using virtual reality or a guided visit","route":"/ideas/idea-pu-radiotherapy-walkthrough-before-planning/"}],"cancer":[{"id":"breast-cancer","kind":"cancer","name":"Breast cancer (all types)","route":"/cancers/breast-cancer/"}],"section":[{"id":"radiation","kind":"section","name":"Radiation Therapy","route":"/fronts/radiation/"}],"technology":[{"id":"respiratory-motion-management","kind":"technology","name":"Respiratory motion management (4D-CT, gating, breath-hold, tracking)","route":"/technologies/respiratory-motion-management/"}],"term":[{"id":"deep-inspiration-breath-hold","kind":"term","name":"Deep inspiration breath-hold (DIBH)","route":"/terms/deep-inspiration-breath-hold/"}],"bottleneck":[{"id":"b-patient-voice","kind":"bottleneck","name":"Patients lack understanding, navigation and agency","route":"/bottlenecks/b-patient-voice/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}]}}