Indwelling pleural catheter insertion for the management of malignant pleural effusion: exploring patients’ experiences
Intended for healthcare professionals
Evidence and practice    

Indwelling pleural catheter insertion for the management of malignant pleural effusion: exploring patients’ experiences

Bavidra Kulendrarajah Junior doctor, Oxford Centre for Respiratory Medicine, Churchill Hospital and John Radcliffe Hospital, Oxford, England
Vineeth George Doctor, Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, England
Anand Sundralingam Doctor, Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, England
Rob Hallifax Doctor, Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, England
Eihab Bedawi Doctor, Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, England
Najib Rahman Doctor, Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, England
Catherine Henshall Nurse, Oxford Brookes University, Oxford, England

Why you should read this article:
  • To enhance your knowledge of the treatment options for patients with malignant pleural effusion

  • To learn about patients’ experiences of living at home with an indwelling pleural catheter

  • To understand the potential benefits of self-led care in managing an indwelling pleural catheter at home

Malignant pleural effusion is a complication of advanced cancer that causes distressing dyspnoea (breathlessness). An indwelling pleural catheter (IPC) is an option for the management of recurrent effusions; however, patients’ experiences of IPC treatment have not been studied in detail.

This article describes a service evaluation that was undertaken to explore patients’ experiences of IPC treatment when discharged home following insertion. Ten patients with malignant pleural effusion undergoing IPC insertion participated in semi-structured interviews, and the data from these were thematically analysed using the framework method. It was found that most patients reported symptomatic improvement as a result of the IPC, but this did not correlate with functional improvement. One patient had no symptomatic or functional improvement and regretted having the procedure. The IPC was preferred by patients compared with other management interventions they had received previously. Further studies are required to identify which patients are unlikely to experience symptomatic benefit from the use of IPCs.

Primary Health Care. doi: 10.7748/phc.2022.e1777

Peer review

This article has been subject to external double-blind peer review and checked for plagiarism using automated software

Correspondence

bavidra10@gmail.com

Conflict of interest

None declared

Kulendrarajah B, George V, Sundralingam A et al (2022) Indwelling pleural catheter insertion for the management of malignant pleural effusion: exploring patients’ experiences. Primary Health Care. doi: 10.7748/phc.2022.e1777

Acknowledgements

Catherine Henshall is a National Institute for Health and Care Research (NIHR) senior nurse and midwife research leader. She acknowledges the support of the NIHR Oxford cognitive health Clinical Research Facility. The views expressed in this article are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care

Published online: 21 September 2022

Background

Malignant pleural effusion is the presence of malignant cells in the pleura (the serous membrane that lines the space between the lungs and the chest wall cavity) or pleural fluid. It is a known complication of advanced malignancy and is associated with a median survival of between three months and 12 months, depending on the primary malignancy (van de Molengraft and Vooijs 1989). In men the most common malignancy that metastasises to the pleura is lung cancer, while in women it is breast cancer (DiBonito et al 1992). Most patients with malignant pleural effusion experience dyspnoea (breathlessness), which can be distressing and may significantly impair their quality of life (Roberts et al 2010).

Management options for malignant pleural effusion vary widely according to individual patient circumstances. For example, conservative measures involving observation only are often used in patients who are asymptomatic or in the terminal phase of their condition, as invasive procedures would not be appropriate for them. Other patients may receive invasive interventions to drain the pleural effusion. Table 1 shows the management options for malignant pleural effusion.

Table 1.

Management options for malignant pleural effusion

ProcedureDescription
Therapeutic thoracocentesis (therapeutic pleural aspiration)Small chest drain inserted to drain up to 1.5L of fluid
Intercostal drainage followed by talc pleurodesisDrainage of pleural effusion through a small chest drain, followed by the injection of a sclerosing agent through the chest drain to induce apposition of the visceral and parietal pleura
Indwelling pleural catheterTunnelled chest drain that is kept in situ for a short time and is connected to drainage bottles every few days
Pleurodesis via either local anaesthetic thoracoscopy or video-assisted thoracoscopyKeyhole surgical procedure that enables the direct injection of a sclerosing agent into the pleural space

Therapeutic thoracocentesis (therapeutic pleural aspiration) is often the first-line treatment in symptomatic malignant pleural effusion and may be the only procedure required in those who respond well to systemic chemotherapy (Roberts et al 2010). When patients have a limited prognosis or cannot tolerate more invasive procedures, for example due to a suboptimal performance status, thoracocentesis remains the mainstay of management. However, a more definitive approach should be offered in patients with recurrent effusions and a better performance status who have derived symptomatic benefit from initial therapeutic thoracocentesis. Such an approach may involve intercostal drainage followed by talc pleurodesis, an indwelling pleural catheter (IPC), or pleurodesis via either local anaesthetic thoracoscopy or video-assisted thoracoscopy (Dixit et al 2017).

Use of indwelling pleural catheters

IPCs are becoming an increasingly popular option for the management of patients with malignant pleural effusion. This is because an IPC can be inserted as a day case procedure, with drainage then undertaken in the community two to three times per week. Drainage frequency can reduce over time as the volume of fluid collected becomes smaller. The drain is often managed by the district nurse, but it can be managed by the patient with the assistance of a caregiver. The following steps are involved in IPC management (Roberts et al 2010):

  • 1. Remove the protective dressing.

  • 2. Clean the drain using an aseptic technique.

  • 3. Connect the drainage bottle to the drain.

  • 4. Drain the fluid by pressing a button on the tubing, then remove the bottle.

  • 5. Seal the tunnelled IPC with a protective dressing.

Two randomised controlled trials demonstrated that use of IPCs can result in fewer initial hospitalisation days and fewer further invasive pleural drainage procedures than talc pleurodesis, while also improving patients’ symptoms and quality of life (Davies et al 2012, Thomas et al 2017). However, a retrospective case series of patients with IPCs demonstrated that patients often require additional IPC-related reviews post-insertion and regular home IPC drainage (Asciak et al 2019).

While the efficacy of IPCs has been investigated through measuring hospitalisation days and complication rates, no studies have directly addressed patients’ experience of them. One study that examined the socio-economic effects of IPCs through quality-of-life questionnaires found that most patients (n=17/20) required assistance from a non-paid caregiver and that for a minority (n=4/20) the IPC limited their activities of daily living to such an extent that their quality of life was impaired (Aboudara et al 2021). This article describes a pilot service evaluation project that was undertaken to explore this area further.

Key points

  • Malignant pleural effusion is a complication of cancer that causes distressing dyspnoea

  • An indwelling pleural catheter (IPC) can relieve the symptoms of malignant pleural effusion for some patients

  • An IPC can be inserted as a day case procedure and drainage can be undertaken in the community by family members or district nurses

  • Participants in this service evaluation managed the IPC at home relatively well, with few complications

  • Further training post-IPC insertion could increase the confidence of patients and their family members in IPC management and identification of complications

Aim

To explore patients’ experiences of IPC treatment when discharged home following insertion. The main areas of interest were: patients’ initial views about the IPC; the effect of the IPC on symptoms; tolerance of the IPC; and attitudes towards self-led IPC care compared with nurse-led IPC care.

Method

This was a qualitative service evaluation that entailed semi-structured interviews with patients with malignant pleural effusion. It was conducted between September 2020 and January 2021.

Setting

Patients aged ≥18 years with probable or confirmed malignant pleural effusion were selected sequentially from the pleural procedure list at a tertiary centre in southern England. A researcher (BK) independent of the pleural team asked patients if they were willing to take part in a telephone interview, in line with coronavirus disease 2019 (COVID-19) risk mitigation procedures at the time. It was explained to the participants that the purpose of this interview would be to find out about their experiences of living with an IPC.

Participants

The target recruitment was ten patients, as this was a pilot project. Eligibility criteria were patients aged ≥18 years who were treated at the participating hospital. Patients were excluded if they were aged <18 years, receiving end of life care or if they were unable to provide informed consent to participate. In total 18 eligible patients were identified, but eight of them were excluded because they were not able to take part in interviews due to: death before being invited for interview (n=3); receiving end of life care in a hospice (n=2); dementia (n=2); or deafness (n=1). Table 2 shows the participant demographics.

Table 2.

Participant demographics (n=10)

CharacteristicsParticipants
Age:
  • Mean age (years)

  • Age range (years)

73
55-90
Gender:
  • Male

  • Female

4
6
Primary malignancy:
  • Ovarian

  • Lung

  • Mesothelioma

  • Renal

  • Pancreatic

  • Breast

2
2
3
1
1
1
Care:
  • Nurse-led care

  • Self-led care

7
3

Post-IPC insertion, management was either nurse-led, with district nurses draining fluid at home one to two times per week, or self-led, with patients managing the drain themselves. In the nurse-led care group, district nurses visited patients’ homes one to two times per week to drain the IPC.

Data collection

The semi-structured interviews were performed by a researcher (BK) who had received training in qualitative interviewing and was not involved in patient care, to avoid bias. The researcher was female, 26 years old and had a clinical background in general medicine. Interviews occurred 2-4 weeks post-IPC insertion, depending on patient availability. A topic guide was used to ensure that all relevant points were addressed. The topic guide, which was clinician-derived, explored three main areas:

  • Experience with the IPC.

  • Thoughts on self-led care.

  • Thoughts on nurse-led care.

The topic guide was initially piloted with three patients and no changes were made to it. Probes were used to explore issues in greater detail. Interviews were audio recorded using a digital voice recorder with participants’ permission. Each interview lasted approximately 30 minutes (range 15-40 minutes).

Data analysis

Thematic analysis of the transcripts was undertaken using a combination of inductive and deductive approaches, as well as the framework method. A researcher (BK) coded the first three transcripts inductively and the codes formed an initial coding framework. Codes that were related were grouped together into categories. The codes and categories were entered into a spreadsheet under preformed headings that were deduced from the interview topic guide questions. These headings formed the themes that are reported on in this article. The framework method was used to compare the interview data within and across participants (Gale et al 2013).

To ensure rigour and transparency, group meetings were held with members of the research team to discuss findings and to aid interpretation of the data. In terms of reflexivity, the researcher was aware of the effect her role as a medical professional may have had on the interview data collection and analysis process, due to preconceived assumptions, belief and perceptions about the benefits and challenges relating to the use of IPCs. As a result, the research team was interdisciplinary, comprised of specialist nurses and doctors, to ensure that a wide range of viewpoints were considered.

Ethics

Ethical approval was not sought as this was a service evaluation project. However, ethical processes were followed and adhered to at all times, including obtaining verbal informed consent from participants before they were interviewed. Participants were informed that there was no obligation to take part and that their decision regarding participation would have no implications for their treatment or care. Any clinical issues or concerns raised by participants were escalated to the clinical team. Audio recordings were transcribed verbatim and anonymised by the same researcher who conducted the interviews. Patient confidentiality was maintained by removing patients’ names from the interview transcripts.

Findings

The following themes were identified from the interviews:

  • Symptoms before IPC insertion.

  • Attitudes towards the IPC.

  • Experience of the IPC.

  • Symptom improvement with the IPC.

  • Preferences for an IPC over other procedures.

  • Experience of nurse-led versus self-led care.

The participant quotes indicate the patients’ age range, gender, underlying primary cancer and model of care.

Symptoms before indwelling pleural catheter insertion

Participants listed a variety of symptoms caused by the malignant pleural effusion, including breathlessness, coughing, chest pain and back pain. One participant’s only symptom was pain under her left arm:

‘I had a pain under my left arm. I thought it was that I had reached up hard to get something of the top shelf. I thought I just pulled a muscle.’ (90s, female, mesothelioma, nurse-led care)

The duration of these symptoms before the IPC was inserted varied from a few weeks to more than one year. In some participants, other procedures such as therapeutic thoracocentesis and talc pleurodesis were trialled first. Another cause of delay was participants not wanting to put additional pressure on healthcare staff during the COVID-19 pandemic:

‘I didn’t want to bother the hospital doctors.’ (60s, female, ovarian cancer, nurse-led care)

Participants reported that before IPC insertion their symptoms significantly affected their quality of life, with limited exercise tolerance and restricted functioning:

‘I can’t stand for long, I couldn’t go down the stairs, I have a real trouble walking.’ (80s, male, mesothelioma, nurse-led care)

‘Well, everything was a struggle.’ (70s, male, lung cancer, nurse-led care)

Attitudes towards the indwelling pleural catheter

Participants’ initial thoughts about the IPC varied. Some of them mentioned they were keen to go ahead with the procedure because it provided them with hope that it would improve their symptoms. In these participants there was a sense of desperation to control their breathlessness:

‘I was relieved that something could be done about my breathing.’ (70s, female, renal cancer, nurse-led care)

There was also apprehension regarding the IPC, potentially because it was a novel concept for most of the participants:

‘Well, I didn’t like the idea of having something inside of me to tell you the truth. I thought it would be a bit awkward.’ (60s, female, ovarian cancer, nurse-led care)

‘I had never heard of the IPC before.’ (90s, female, mesothelioma, nurse-led care)

A few participants felt that the IPC was presented to them as the only management option and that alternatives were not discussed. One participant felt that this stopped them from making an informed decision:

‘I don’t think anyone explained to me what would happen if I didn’t have it in. I just went along with it really.’ (60s, female, pancreatic cancer, self-led care)

Experience of the indwelling pleural catheter

Most of the participants appeared to tolerate the procedure well. Some of them were highly positive, reporting that the procedure was explained to them well beforehand and that the use of leaflets and diagrams helped them to understand what would occur during the procedure, thus making them feel well prepared. The most common immediate complication during and following the procedure was pain or discomfort. However, there was wide variation in participants’ experiences of these during the procedure:

‘It didn’t hurt, I was given a local anaesthetic and I didn’t feel anything. They explained everything to me during the procedure and I thought it was very helpful.’ (70s, female, ovarian cancer, nurse-led care)

‘Having it put in was very traumatic. This should be put out and warn people. They hit a few nerves and made me feel very uncomfortable and I am in lots of pain, and I am trying to get on top of that.’ (60s, female, pancreatic cancer, self-led care)

Post-discharge, participants coped with the IPC relatively well. In the first few weeks, for several participants the IPC was an inconvenience but did not affect their day-to-day life. The inconveniences reported by participants included not being able to sleep on the side of the drain, limitations with showering, and being aware of the dressing and the drain bag attached to the IPC:

‘It was just there when it was sitting down or lying down. It was trying to remember not to press on it or pull it.’ (50s, female, lung cancer, self-led care)

‘It hasn’t made a difference to my day-to-day life. So, you know I seem to be coping alright.’ (60s, female, ovarian cancer, nurse-led care)

A few participants had further minor issues with the IPC, such as the dressing coming off and a small amount of bleeding from the IPC site. These issues were resolved by the pleural nurse visiting the individual at home the next day.

Symptom improvement with the indwelling pleural catheter

Most participants reported they had symptomatic improvement in their breathlessness after the IPC was inserted. Some felt immediate relief, while for others there was gradual improvement over a few weeks. Participants who noted symptomatic relief did not feel it always correlated with the amount of fluid drained:

‘I had instant relief when the drain was inserted.’ (70s, female, renal cancer, nurse-led care)

‘I feel there’s no real link between how much fluid is drained off and the way my breathing feels.’ (90s, female, mesothelioma, nurse-led care)

For a few participants, the amount of fluid drained decreased with repeated drainage over several weeks. However, symptomatic improvement did not always correlate with functional improvement. Although breathlessness improved, many participants believed they could not do much more than before the IPC was inserted. One participant described how their breathlessness at rest was the greatest improvement. The lack of functional improvement meant that some participants’ expectations were not met. Despite this, many participants stated they would still choose the IPC if given the choice:

‘Not a lot, I still can’t stand for too long, go up or down the stairs.’ (80s, male, mesothelioma, nurse-led care)

‘Well, it has made a difference, but it is a different kind of breathlessness. It is hard to explain. It is now a gentler type of breathlessness.’ (70s, male, lung cancer, nurse-led care)

‘I’m still having difficulty breathing. It has not improved my breathing as I hoped it would either. I definitely would choose the IPC if I was to go back in time.’ (60s, female, breast cancer, self-led care)

A few participants did not experience any improvement in their breathlessness after IPC insertion. They expressed disappointment in the IPC, with one of them stating:

‘It doesn’t give me any relief when I take fluid out. I’m still very breathless. I can’t walk very far. I used to love walking. It hasn’t helped me at all.’ (60s, female, pancreatic cancer, self-led care)

Preferences for an indwelling pleural catheter over other procedures

For some participants, other procedures such as therapeutic thoracocentesis and talc pleurodesis had been attempted before IPC insertion. These participants were asked to compare their experiences of different management interventions with the IPC, and most preferred the IPC. The reasons given for this included the ability to be managed at home and greater symptomatic improvement. Before having an IPC inserted, one participant had to attend hospital two to three times per week, which they found intensive, and expressed relief when they were told the IPC would enable them to be managed at home:

‘It is a lot easier because I didn’t have to keep going to the hospital to have the fluid taken off. I preferred this as I could spend more time at home.’ (80s, male, mesothelioma, nurse-led care)

Experiences of nurse-led care versus self-led care

Three participants in the self-led care group had their drains managed by family members. These family members had observed the nurse conduct drainages several times before feeling confident to do so themselves. Participants expressed that it was relatively easy for their family members to learn how to manage the drain:

‘She showed us what to do and then we followed the booklet. It is quite easy to do.’ (60s, female, pancreatic cancer, self-led care)

Those in the self-led care group had direct access to district nurses in case of any issues; however, during the first few weeks of managing the drain they did not require this additional support. In the self-led care group, participants preferred having family members manage the IPC rather than nurses. One reason for this was they preferred to have a family member conducting such an intimate procedure:

‘I prefer my family because it’s quite an intimate thing.’ (60s, female, breast cancer, self-led care)

An additional reason reported by participants was that self-led care gave them greater independence to conduct drainage when they wanted. It enabled them to drain the fluid when they were most symptomatic without having to wait for a district nurse:

‘I can do it when I want to do it. When I feel that I can’t breathe, I can do it right now. So, I don’t have to wait for the nurses.’ (60s, female, breast cancer, self-led care)

‘Also, they couldn’t tell us a time they would be here, so we were waiting all the time for them’ (50s, female, lung cancer, self-led care)

However, one participant mentioned that it was time-intensive to look after the IPC because they had to change the drain more often than expected:

‘I’m having to change the drain a lot more often that I thought I would have to.’ (60s, female, breast cancer, self-led care)

Participants in the nurse-led care group found it easy to access the nurses, appreciated their clinical input and enjoyed the company when the nurses visited:

‘I have the same nurse, very friendly and chatty.’ (80s, male, mesothelioma, nurse-led care)

In the nurse-led care group there was general reluctance to switch to self-led care. One reason for this was low confidence in identifying complications with the IPC. Participants often felt dependent on nurses to identify issues and escalate this to the hospital team:

‘I wouldn’t know when things were going wrong, and I wouldn’t know when there is a problem and when to go into hospital.’ (80s, male, mesothelioma, nurse-led care)

Another reason was that the drain was relatively inaccessible and participants often did not want to burden family members by asking them to help to drain the fluid:

‘It’s in an awkward place. It is under my left arm. So, I think to do it yourself it would be awkward. You would need both hands and it would be hard for me.’ (70s, female, ovarian cancer, nurse-led care)

‘I might have to disturb my family which I don’t want to do.’ (80s, male, mesothelioma, nurse-led care)

Participants and family members in the nurse-led care group were happy to trial self-led care of the IPC when asked. Some family members thought it would be beneficial for them to receive training because this would enable them to manage the drain in an emergency or when the district nurses were unavailable. One participant reported that one of their family members felt confident to manage the drain because she had observed the nurses do so multiple times, but was not aware this was an option:

‘My daughter thought she might want to do it just in case someone couldn’t come. We haven’t really discussed it with the nurses though.’ (80s, male, mesothelioma, nurse-led care)

‘No one has really offered for me to do it myself or suggested it.’ (80s, male, mesothelioma, nurse-led care)

‘I’m there when they drain the IPC. I’m there all the time. They haven’t actually said do this and do that. I’m there all the time. So, I feel like I would know what to do.’ (70s, female, renal cancer, nurse-led care)

Discussion

To the authors’ knowledge, this is the first project to use semi-structured interviews to explore patients’ experiences post-IPC insertion. The findings demonstrate that patients with malignant pleural effusion are generally happy to trial the IPC and managed at home relatively well, with few complications. While some participants reported mild inconveniences with the drain, they did not find it negatively affected their day-to-day life substantially. This contrasts with a study by Aboudara et al (2021) which found that 30% (n=6/20) of patients surveyed felt there were activities they could no longer perform because of their IPC, of whom 50% (n=3/6) felt it negatively affected their quality of life and well-being. However, no explanation was provided by the participants in terms of how their quality of life was affected. The patients in Aboudara et al’s (2021) study were from a cohort with benign and malignant pleural effusions. Therefore, it is possible that the population was less functionally restricted and less symptomatic than the patients interviewed in this service evaluation.

Most participants in this service evaluation reported symptomatic improvement in breathlessness after IPC insertion. This finding is in keeping with two randomised controlled trials which showed that breathlessness improved after IPC insertion (Davies et al 2012, Thomas et al 2017). In both trials, the visual analogue scale (VAS) was used to measure improvement before and after the intervention, based on a 100mm scale to indicate the severity of breathlessness. However, the VAS scoring system is limited in that it does not show how improvement in breathlessness correlates to functional activity and quality of life.

In this service evaluation, although many of the participants experienced improvement in breathlessness, this did not correlate with functional improvement. Some participants stated that they were frail and functionally highly limited before and after IPC insertion. However, despite the lack of functional improvement, most participants expressed that they would still have an IPC if given the choice. This is consistent with a study by Banka et al (2020), which showed that pleural intervention did not have any effect on physical activity, despite improvement in VAS scores. This indicates that even in the absence of functional improvement, significant benefits can be achieved through definitive effusion control by improving breathlessness.

A few of the participants were disappointed at the lack of functional improvement. Therefore, the authors suggest that before IPC insertion, there should be a realistic discussion between the respiratory doctor or nurse and the patient regarding the extent to which the IPC is likely to affect their quality of life, functional status and symptom control. Further studies are necessary to characterise the improvement in breathlessness after the intervention and how this correlates with functional activity.

One participant in this service evaluation felt there was no relief when fluid was drained and that the IPC had no positive effect. This lack of benefit is in keeping with two prospective studies which demonstrated that a small proportion of patients report no symptomatic improvement following therapeutic pleural intervention (Mishra et al 2015, Muruganandan et al 2020). Mishra et al (2015) identified that 6% of patients did not report worthwhile improvement in breathlessness after fluid drainage, while the Pleural Effusion And Symptom Evaluation (PLEASE) study (Muruganandan et al 2020) found that 27% of patients did not have clinically significant improvement in breathlessness following therapeutic drainage. Further studies are required to identify which patients are unlikely to benefit from pleural intervention, to reduce unnecessary hospital admissions and healthcare costs. For these patients, other forms of supportive care and symptom management may need to be considered.

In this service evaluation, those with malignant pleural effusion generally preferred IPCs over other management interventions because they can be managed at home. The IPC was drained by either the district nurse or family members. The participants recognised that they were terminally ill and spending time at home was a clear priority for them. Another reason why some preferred home-based care was due to frailty and associated issues with travelling to hospital for interventions.

In the self-led care group, participants’ family members generally conducted fluid drainage. This was an easy procedure for them to learn and participants often preferred family members to manage their drain because it gave them greater independence. In comparison, participants in the nurse-led care group were reluctant to switch to self-led care because they did not have the confidence to identity complications. When family members were asked, they were happy to trial draining the IPC, but often did not know this was an option. Therefore, self-led IPC care should be offered to all patients and their family members, and this should be followed up with a training programme suited to their needs. The decision to switch to self-led care should be based on various factors, including the availability of family members and other social support structures, as well as the patient’s level of independence. It is also important for district nurses to revisit patient and family preferences for self-led care periodically and not to make assumptions about what patients may want or need.

Limitations

There are several limitations to this service evaluation, including the relatively small sample size. Due to the COVID-19 pandemic, fewer IPC procedures were performed, leading to the recruitment of fewer participants. Furthermore, the semi-structured interviews were conducted by telephone rather than in person, which may have influenced the data collection. Despite these limitations, this service evaluation offers rich insights into patients’ experiences with an IPC.

The service evaluation would have been further enhanced by the purposive sampling of additional participants with characteristics of interest, for example those with less family support, and a range of living situations, for example nursing homes. Interviews occurred 2-4 weeks post-IPC insertion, which may have been too short a time frame to identify whether patients experience long-term issues and improvements with the use of IPCs. Therefore, longer-term follow-up studies are required.

Further research

Following this pilot service evaluation project, the authors plan to undertake a mixed-methods study, which will include a large qualitative component exploring how patients cope with an IPC over a longer time frame and comparing experiences of different therapeutic interventions for malignant pleural effusion. This will be combined with a quantitative study to derive predictive markers that would identify patients with malignant pleural effusion who are unlikely to experience symptomatic improvement with an IPC.

Conclusion

The findings of this service evaluation suggest that, from the perspective of patients with malignant pleural effusion, the IPC is a well-tolerated management intervention and that most patients experience symptomatic improvement at rest. Further training could be provided post-IPC insertion to enable patients and their family members to feel increasingly confident in IPC management and identifying complications.

References

  1. Aboudara M, Roller L, Lentz R et al (2021) A survey-based study of patient-centered costs associated with indwelling pleural catheters. American Journal of Hospice & Palliative Care. 38, 4, 361-365. doi: 10.1177/1049909120954810
  2. Asciak R, Hallifax RJ, Mercer RM et al (2019) The hospital and patient burden of indwelling pleural catheters: a retrospective case series of 210 indwelling pleural catheter insertions. Respiration. 97, 1, 70-77. doi: 10.1159/000491934
  3. Banka R, Castro-Anon O, Hassan M et al (2020) A study of physical activity and sedentary behaviour in patients with malignant pleural effusion undergoing therapeutic interventions: ASPIRE. European Respiratory Journal. 56, Suppl 64, 4496. doi: 10.1183/13993003.congress-2020.4496
  4. Davies HE, Mishra EK, Kahan BC et al (2012) Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial. JAMA. 307, 22, 2383-2389. doi: 10.1001/jama.2012.5535
  5. DiBonito L, Falconieri G, Colautti I et al (1992) The positive pleural effusion. A retrospective study of cytopathologic diagnoses with autopsy confirmation. Acta Cytologica. 36, 3, 329-332.
  6. Dixit R, Agarwal KC, Gokhroo A et al (2017) Diagnosis and management options in malignant pleural effusions. Lung India. 34, 2, 160-166. doi: 10.4103/0970-2113.201305
  7. Gale NK, Heath G, Cameron E et al (2013) Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology. 13, 117. doi: 10.1186/1471-2288-13-117
  8. Mishra EK, Corcoran JP, Hallifax RJ et al (2015) Defining the minimal importance difference for the visual analogue scale assessing dyspnea in patients with malignant pleural effusions. PLoS One. 10, 4, e0123798. doi: 10.1371/journal.pone.0123798
  9. Muruganandan S, Azzopardi M, Thomas R et al (2020) The Pleural Effusion and Symptom Evaluation (PLEASE) study of breathlessness in patients with a symptomatic pleural effusion. European Respiratory Journal. 55, 5, 1900980. doi: 10.1183/13993003.00980-2019
  10. Roberts ME, Neville E, Berrisford RG et al (2010) Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 65, Suppl 2, ii32-ii40. doi: 10.1136/thx.2010.136994
  11. Thomas R, Fysh E, Smith N et al (2017) Effect of an indwelling pleural catheter vs talc pleurodesis on hospitalisation days in patients with malignant pleural effusion. The AMPLE randomized clinical trial. JAMA. 318, 19, 1903-1912. doi: 10.1001/jama.2017.17426
  12. van de Molengraft FJ, Vooijs GP (1989) Survival of patients with malignancy-associated effusions. Acta Cytologica. 33, 6, 911-916.

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