The Role of Preparatory Mobile App Breath-Hold Coaching for Left-Sided Breast Radiotherapy in Patient Preparedness and Anxiety

Abstract

Purpose/Aim

Deep Inspiration Breath Hold (DIBH) technique is standard of practice for treating left-sided breast cancers as it reduces cardiac dose and limits late cardiac toxicities. The success of DIBH depends on patients’ ability to hold their breath, which may not be intuitive. Recent studies suggest that DIBH technique provokes patient anxiety which can interfere with breath-hold performance. Preparatory training for DIBH has been shown to reduce patient anxiety, however no research has explored preparatory DIBH training via mobile device apps. The aim of this study was to determine whether preparatory DIBH training with a mobile app improved anxiety and preparedness for breath-hold at CT simulation.

Methods/Process

This prospective parallel study consisted of two groups. The control group received the standard DIBH information sheet as education at time of radiation oncology consult, while the experimental cohort received the information sheet with additional breath-hold practice instructions using an app. In the experimental group, CT simulation was booked to occur no earlier than one week after consult so there could be time to practice with the app. Upon completion of the CT simulation appointment, both groups completed a short questionnaire. Survey results were compiled and analyzed using Fischer's Exact test and nonparametric Mann-Whitney tests.

Results or Benefits/Challenges

A total of fifty participants were recruited to the study, with twenty-five participants in each group. There were no significant differences in age (p=0.65), education level p=0.085), or anxiety prior to the CT simulation appointment (p=0.75), measured using a distress thermometer tool, between the two groups. Both groups felt the education they received prior to simulation was adequate, with 92% in the control group and 95.5% in the app group indicating they were very satisfied or satisfied. And both groups felt similar levels of confidence about holding their breath during their simulation, with 88% and 90.9% in the control and experimental groups, respectively, feeling very confident or confident. However, the proportion who felt prepared or somewhat prepared for their simulation appointment was higher in the experimental group (95.4%) compared to the control group (84%), and this difference was significant (p=0.042). For those patients in the experimental group, 77.3% found the app easy to use and 86.4% felt it helped with preparation for simulation. The same proportion (86.4%) felt that it reduced their anxiety level.

Conclusions/Impact

Preparatory DIBH training with a mobile device app did not have a statistically significant effect on patient anxiety or confidence of performing breath-holds during CT simulation. Patients in the experimental cohort did feel significantly better prepared for their simulation appointment and most found the app very easy to use. Our evidence suggests preparatory mobile training could be an effective tool to prepare patients for breath-hold, but the one week minimum between consult and simulation in the app-coaching group may be a confounding factor that needs to be further investigated. Usage of the app for pre-simulation education appears to have no negative effects and does not increase patient anxiety in any way.