Barriers and facilitators of chronic breathlessness digital self-management interventions in people living with lung cancer and chronic obstructive pulmonary disease - a systematic review and narrative synthesis

Abstract Background Recent research highlighted the expansion of telehealth has accelerated and will continue unabated. Patients with advanced chronic respiratory diseases experience breathlessness, often to a debilitating extent. This review aims to identify the barriers and facilitators to self-management, digital health intervention implementation, focusing on managing pain and breathlessness, in community-dwelling adults living with lung cancer and/or Chronic Obstructive Pulmonary Disease. Methods A systematic review of the literature following PRISMA guidelines, searching Medline, Embase, Cochrane Library and CINAHL databases, with two searches performed in June 2021 and April 2022. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT) and the PARIHS framework was employed to extract key data. The findings were summarised via narrative synthesis and interventions classified according to the World Health Organization framework for digital health interventions. Results Twenty-four included studies indicate the current literature is highly heterogeneous in terms of both quality and study types. Barriers and facilitators towards intervention implementation were found. Ease of use, a good degree of intervention accessibility and financial savings over standard care were among the strongest facilitators. Advanced patient age, lack of technological skills or trust, variability of patient needs and unused data appeared as some of the main barriers. Discussion Involving all stakeholders during the early stages of planning, particularly patients and healthcare practitioners is very likely to increase chances of intervention implementation success. Interventions also should not increase burden on healthcare practitioners and implementing interventions locally appears to be more effective. Conclusions New knowledge is provided via a list of barriers and facilitators towards self-management interventions implementation. Earlier disease staging, younger target populations and advanced healthcare settings are likely to be the strongest facilitators towards implementation success, while healthcare practitioners will need additional support. Given the current fragmented state of the literature on this topic, future studies should focus on longer-term effectiveness and adherence of digital health interventions in chronic breathlessness, conducted both qualitatively and quantitatively.