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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.
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.
What 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.
Language. 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.
Adoption of early coaching is not measured by any source OnCo found.
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Shares Patients lack understanding, navigation and agency and the tags protocol-upgrade, upgrade:promising.
Shares Patients lack understanding, navigation and agency and the tags protocol-upgrade, upgrade:promising.
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