Systematic enhancement of existing breathlessness protocols through CURACO framework integration: a novel approach to ethical clinical excellence

Current breathlessness evaluation protocols rely primarily on clinical expertise and biomarker interpretation, achieving variable diagnostic accuracy across healthcare settings. Traditional protocols focus on diagnostic efficiency without systematically addressing patient empowerment, healthcare equity, or integration of safety, understanding, research, authenticity, ethics, and technology principles. Emergency department protocols for heart failure diagnosis demonstrate accuracy limitations with sensitivity ranging 65-66% using conventional approaches, while specialist interpretation varies significantly with Fleiss's kappa of 0.46 indicating moderate agreement among clinicians [1].

To develop and apply the CURACO framework (Clinical safety, Understanding, Research-informed care, Authentic patient-centred approaches, Conscientious ethics, and Optimised technology) for systematic enhancement of existing breathlessness evaluation protocols. We aimed to demonstrate framework utility in transforming traditional diagnostic approaches into patient-centred, ethically robust clinical tools.

We developed the CURACO framework through systematic integration of six foundational principles: safety-first protocols ensuring patient protection, understanding enhancement through patient education, research-informed guidelines incorporating evidence-based practices, authentic patient-centred approaches respecting individual values, conscientious ethics addressing healthcare equity, and optimized technology facilitating collaboration. The framework was applied to analyse existing breathlessness protocols, including BNP-based algorithms, clinical decision rules, and imaging-guided approaches.

CURACO framework application revealed significant enhancement opportunities in existing breathlessness protocols. Current approaches demonstrate substantial diagnostic accuracy variations: BNP testing achieves sensitivity of 94.1% and specificity of 74.5% for cardiac dyspnoea [2], while AI-enhanced protocols reach 96.5% overall accuracy [1]. Framework analysis identified critical gaps in patient understanding components, with studies showing variable clinician interpretation accuracy (Fleiss's kappa 0.46) [1]. Bedside ultrasonography protocols showed superior performance (AUC 86.4%) compared to traditional BNP approaches (AUC 66.3%) [2], yet lack systematic ethical integration.

The CURACO framework provides systematic methodology for enhancing existing breathlessness evaluation protocols through ethical integration and patient-centred design. This approach transforms traditional diagnostic protocols into comprehensive tools serving both clinical excellence and healthcare equity. While this framework development shows broad applicability, prospective validation studies across multiple healthcare settings are needed to establish implementation effectiveness.