Hypnosis on Breathlessness Mastery in Patients With Persistent Dyspnea

Effectiveness of Hypnosis on Breathlessness Mastery in Patients With Persistent Dyspnea: a Randomised Controlled Trial

Persistent dyspnea is a debilitating symptom, that is common and difficult to treat. This symptom is found in many different diseases including chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), chronic heart failure (CHF), and metastatic cancer. Dyspnea is associated with many other symptoms, including anxiety, depression, and fatigue and is responsible for a significant reduction in quality of life. To date, only opiates are recommended for the pharmacological treatment of persistent dyspnea.

The effectiveness of hypnosis is well known in the treatment of anxiety and delivered to patients suffering from chronic dyspnea for this reason. One randomised controlled study has shown that a single 20-minute mindfulness sessions could significantly reduce general symptom burden and have a significant impact on anxiety and depression in palliative care patients. Furthermore, the intervention had no negative side effects.

Our aim is to evaluate the effectiveness of three hypnosis sessions on breathlessness mastery in patients with persistent dyspnea, using as a primary outcome the mastery domain of a validated tool, the Chronic Respiratory Questionnaire (CRQ).

Hypnosis is currently used to reduce anxiety in patients with breathlessness. Although a reduction in anxiety has been correlated with a reduction in dyspnea, the effectiveness of hypnosis on breathlessness self-management has not yet been evaluated. As medical options for the treatment of chronic persistent breathlessness are limited, finding new, innovative ways, to help patients feel more confident in the management of their dyspnea should be a priority. Some interventions such as pulmonary rehabilitation, the hand-held fan and walking aids have been proven to be effective. However, patients with advance disease may not be well enough to endure physical interventions such as pulmonary rehabilitation.

Hypnosis has been shown to be safe and to diminish anxiety in patients suffering from Chronic Obstructive pulmonary disease (COPD). The risk linked to hypnosis is considered minimal as participants may interrupt the hypnosis session at any time and there are no known side effects to hypnosis. Additionally, patients could benefit from the proven reduction of anxiety. The benefits for patients clearly outweigh the risks.

The objective of this prospective parallel randomised controlled trial is to determine the effectiveness of hypnosis on breathlessness mastery in patients with persistant dyspnea and advanced disease. The primary endpoint is the patient-reported breathlessness mastery as measured with the mastery subscale of the Chronic Respiratory Questionnaire (CRQ) after three hypnosis sessions.

Participants will undergo three 15-minute individual hypnosis intervention, conducted by a trained hypnotherapist, with a two-week interval between each session. A guide has been developed by two experimented hypnotherapists specifically for this intervention and will be used for all sessions. The control group will undergo usual care (no hypnosis).

Participants will be recruited at the outpatient consultations of cardiology, pneumology, oncology, primary care and palliative care of the Geneva University Hospital (single centre) by their treating physician. All eligible participants will be presented with the objectives of the study, the procedures involved, the timing of the intervention and will receive an information sheet about the study. Eligible participants will be contacted by a research associate in the following days. If they consent to participate, participants will be randomised to receive either the intervention (3 hypnosis sessions) or usual care.

At inclusion time (T0), all participants will be asked to complete a set of questionnaires: the Chronic Respiratory Questionnaire (CRQ), the Hospital Anxiety and Depression Scale (HADS), the Dyspnea-12 questionnaire (D-12) and the European Quality of Life 5 DImensions 5 Level Version (EQ5D5L), as well as score their worst breathlessness on a numerical scale from 0 to 10, 0 being no breathlessness and 10 worst imaginable breathlessness. These questionnaires will be repeated at the end of the third session. Following the final (third) hypnosis session, participants will be asked about the acceptability of the intervention on a 5-point Likert scale ranging from 0 (not acceptable) to 5 (totally acceptable).

A follow up with the CRQ will be conducted 1 month after the end of the last session.

Inclusion Criteria:

• Patients aged ≥ 18 years and
• Primary diagnosis of metastatic cancer, COPD stage at least B or E, ILD, or CHF and
• Dyspnea stage NYHA ≥ II or mMRC ≥ 2

Exclusion Criteria:

• Have had hypnosis treatment in the last 12 months
• Have an estimated life expectancy of less than 6 months
• Have participated in pulmonary rehabilitation in the last 6 months
• Have been hospitalised in the last month (30 days)
• Are unable to come to the hospital for 3 outpatient consultations (1 every two weeks)
• Have a condition that would interfere with their ability to respond to the questionnaires (i.e. cognitive impairment, hearing impairment, etc.)
• Are not eligible for a hypnosis session due to a psychiatric disorder