Resource to prepare patients for deep inspiration breath hold: the RESPIRE project

Introduction: Incidental irradiation of the heart during radiotherapy can have long-term consequences(1). Deep Inspiration Breath Hold (DIBH) is used for patients receiving radiotherapy for breast cancer to reduce heart doses(2). DIBH can reduce mean heart dose by between 29-67% compared with free breathing(3); differences in dose reduction may be due to patient anatomy or variability in chest expansion achieved at an individual level(4). A survey of a breast cancer special interest group (BRIG) identified patient compliance, ability to hold their breath for the required time, and reproducibility of breath hold as major challenges to implementing DIBH. Between 12-21% of patients are reported to find the technique challenging(5, 6). While coaching has been shown to reduce maximum heart dose compared with non-coached patients(7), formal coaching is not typical in most radiotherapy centres and no standard patient resource exists to support practice prior to radiotherapy planning. Aim: To develop a series of instructional videos to enhance the number of patients that can achieve breath hold, improve patient self-efficacy and patient satisfaction with care. Method: The Medical Research Council (MRC)(8) framework for complex interventions was adopted. A co-design methodology(9) involving patient representatives and health practitioners (HCP) was used to develop a series of instructional videos and podcasts. Co-design workshops were audio recorded and transcribed verbatim. Video scripts were based upon themes identified through framework analysis. To minimise bias member checking was adopted and patient representatives participated in video scripting; to maintain the outputs' authenticity they also appeared as patients in the videos. Results: Key themes from the PPI workshop included: information needs; positioning during radiotherapy; and pre-treatment readiness. Additional themes from the HCP workshop included DIBH service challenges and teaching the DIBH technique. Five videos and two podcasts were developed. Conclusion: This presentation will highlight how participatory co-design facilitated video development to support a more effective DIBH experience. Resource examples will be presented alongside initial feedback from patient representatives and HCPs on suitability and usability. The next stage will assess the resources' effectiveness in supporting breath hold capability.