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A Study of Applying the Use of Breathing Training to Palliative Care Patients, Based on the Bio-Psycho-Social Model

Authors: Wenhsuan Lee, Yachi Chang, Yingyih Shih


In clinical practices, it is common that while facing the unknown progress of their disease, palliative care patients may easily feel anxious and depressed. These types of reactions are a cause of psychosomatic diseases and may also influence treatment results. However, the purpose of palliative care is to provide relief from all kinds of pains. Therefore, how to make patients more comfortable is an issue worth studying. This study adopted the “bio-psycho-social model” proposed by Engel and applied spontaneous breathing training, in the hope of seeing patients’ psychological state changes caused by their physiological state changes, improvements in their anxious conditions, corresponding adjustments of their cognitive functions, and further enhancement of their social functions and the social support system. This study will be a one-year study. Palliative care outpatients will be recruited and assigned to the experimental group or the control group for six outpatient visits (once a month), with 80 patients in each group. The patients of both groups agreed that this study can collect their physiological quantitative data using an HRV device before the first outpatient visit. They also agreed to answer the “Beck Anxiety Inventory (BAI)”, the “Taiwanese version of the WHOQOL-BREF questionnaire” before the first outpatient visit, to fill a self-report questionnaire after each outpatient visit, and to answer the “Beck Anxiety Inventory (BAI)”, the “Taiwanese version of the WHOQOL-BREF questionnaire” after the last outpatient visit. The patients of the experimental group agreed to receive the breathing training under HRV monitoring during the first outpatient visit of this study. Before each of the following three outpatient visits, they were required to fill a self-report questionnaire regarding their breathing practices after going home. After the outpatient visits, they were taught how to practice breathing through an HRV device and asked to practice it after going home. Later, based on the results from the HRV data analyses and the pre-tests and post-tests of the “Beck Anxiety Inventory (BAI)”, the “Taiwanese version of the WHOQOL-BREF questionnaire”, the influence of the breathing training in the bio, psycho, and social aspects were evaluated. The data collected through the self-report questionnaires of the patients of both groups were used to explore the possible interfering factors among the bio, psycho, and social changes. It is expected that this study will support the “bio-psycho-social model” proposed by Engel, meaning that bio, psycho, and social supports are closely related, and that breathing training helps to transform palliative care patients’ psychological feelings of anxiety and depression, to facilitate their positive interactions with others, and to improve the quality medical care for them.

Keywords: Palliative care, breathing training, bio-psycho-social Model, heart rate variability.

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[1] Kim SD, Kim HS (2005). Effects of a relaxation breathing exercise on anxiety, depression, and leukocyte in hemopoietic stem cell transplantation patients. Cancer nursing 28:79.
[2] Lehrer PM, Vaschillo E, Vaschillo B, Lu SE, Scardella A, Siddique M, Habib RH (2004). Biofeedback Treatment for Asthma. Chest 126:352-361.
[3] Vanja Duric, Mounira Banasr, Pawel Licznerski, Heath D Schmidt, Craig A Stockmeier, Arthur A Simen, Samuel S Newton & Ronald S Duman. Nature Medicine. Advance online publication, Published online 17 October2010. DOI: doi:10.1038/nm.2219.
[4] C. J. Liu, G. Y. Tu, S. L. Lin, and C. C. Yeh, Comparisons of Different Breathing Ratios of Slow Breathing among Outpatients with Anxiety Disorders. Journal of Medicine and Health, 2014. 3(1): p. 57-66.
[5] W. D. Chang, C. T. Tsai, H. Y. Lin, J. C. Liu, and B. D. Li, Heart Rate Variability and Associated Factors of Women in Menopause. Journal of Disability Research, 2012. 10(3): p. 196-210.
[6] Kreibig, S. D., Autonomic nervous system activity in emotion: a review. BiolPsychol, 2010. 84(3): p. 394-421.
[7] Lehrer, P. M. and R. Gevirtz, Heart rate variability biofeedback: how and why does it work? Frontiers in Psychology, 2014. 5.
[8] Y.F. Hsiung, S. L. Tsai, Y. Y. Wang, and Y. F. Li, The Factors, Evaluation, and Care of the Fear of Disease Progression for Cancer Patients, the Journal of Oncology Nursing, 2016. 16: P.43-56.
[9] Laborde, S., Mosley, E., Thayer, J. F., Heart Rate Variability and Cardiac Vagal Tone in Psychophysiological Research-Recommendations for Experiment Planning, Data Analysis, and Data Reporting. Front Psychol, 2017. 8: p. 213.
[10] O'Connor, M., Wei r, J., Butcher, I., Kleiboer, A., Murray, G., Sharma, N., Sharpe, M. (2012). Pain in patients attending aspecialist cancer service: prevalence and association with emotional distress. Journal of Pain and Symptom Management, 43 (1), 29-38. doi:10.1016 /j.jpainsymman.2011.03.010.
[11] Zhao Huiling, Huang Huiru, Xie Biqing, Su Huifang, 2013; Fu Jen Medical Journal; 11, No. 3 (2013/09/01), P205 – 214.