A randomised pilot of academic detailing in general practitioners for palliative dyspnoea management

Dyspnoea is a common symptom which presents in up to 70% of patients with end stage cancer. It's presence is frightening and distressing for the patient, and management can be problematic for General Practitioners (GP), whose knowledge and experience with symptomatic dyspnoea may be limited. There is good evidence demonstrating the effectiveness of academic detailing (AD) in improving the performance and knowledge of existing practitioners. The aim of this pilot project was to assess the ability of ADto improve the knowledge and confidence of GP who had patients with dyspnoea and cancer.

Eligible participants were drawn from the regional palliative care service, who had a malignancy and symptomatic dyspnoea. Their GP was invited to enroll in the project and randomized to AD (by a senior respiratory/palliative care physician) or usual care. Baseline knowledge, experience and confidence regarding the management of dyspnoea were obtained, and the questionnaires were repeated following the 2 AD visits per participant. Three key messages were delivered: treat reversible causes of dyspnoea, optimizing pharmacological and non-pharmacological methods of dyspnoea control.

A total of 35 GP were randomized to the study, 17 in the intervention arm. Of these, 92% reported the topics covered in the AD sessions were useful, with 83% reporting an increase in knowledge and confidence in the management of dyspnoea. This compares with only 19% of the GP's in the control group who had increased confidence.

This pilot study illustrates the benefit of targeted AD to GP's to enhance their knowledge, management skills and confidence in dealing with symptomatic dyspnoea in the setting of advanced cancer. This will likely translate into better patient care, enhanced QoL and possibly a reduction in hospitalization.

                                                    Confidence    Improved  Same    Intervention 83% 17% Control 19% 81%
Funding: Cancer Council of South Australia