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- Title
A prospective study of patient-centred outcomes in the management of malignant pleural effusions.
- Authors
Walker, Susan; Zubrinic, Marijana; Massey, Christine; Shargall, Yaron; Bédard, Eric; Darling, Gail
- Abstract
Background: In a patient population with a limited life expectancy, malignant pleural effusion can significantly impact quality of life (QoL). Different treatment options are available, each with its own effect on QoL. T o date, satisfaction with treatment options has not been evaluated. Purpose: T o evaluate QoL and satisfaction with treatment using patient-reported outcomes for four different treatment strategies. Design: A prospective, cohort study that compared four treatment options: indwelling pleural catheter (IPC); video assisted thoracic surgery (VATS) and IPC; chest tube and talc slurry; and VATS talc poudrage. Setting: A total of 104 participants were treated across four acute care teaching hospitals in a large Canadian city. Measurements: Patient-reported outcomes were assessed using functional assessment of chronic illness therapy--palliative (FACIT--PAL), London Chest Activity of Daily Living scale and FACIT--treatment satisfaction questionnaires. Results: No significant difference was identified between the four treatments based on patient-reported outcomes. VATS talc poudrage provided the most durable improvement. At the 6-week post-treatment time point, the highest patient satisfaction was noted in patients who received VATS and talc pleurodesis, lowest satisfaction in patients with chest tube and talc pleurodesis; however, the differences were not statistically significant (p=0.20). VATS and talc pleurodesis had the highest scores at 6 weeks for recommendation of treatment to others; however, the comparison with other treatment groups was not statistically significant (p=0.22). For FACIT -PAL, total scores when analysed as one group, there was a statistically significant increasing trend (indicating improvement) (p<0.0001). Breathlessness, measured using the London Chest Activity of Daily Living scale, indicated a statistically decreasing trend, suggesting an improvement (p=0.0003). There was no statistically significant difference in trends over time between the four treatment groups. Conclusions: While all treatment options addressed the patients' symptoms and relieved dyspnoea, an IPC offered effective treatment with minimal discomfort and time in hospital yet still high satisfaction.
- Subjects
CANADA; ACADEMIC medical centers; COMPARATIVE studies; CONFIDENCE intervals; DYSPNEA; LENGTH of stay in hospitals; LIFE skills; LONGITUDINAL method; PAIN; PATIENT satisfaction; PLEURA cancer; PLEURAL effusions; PROBABILITY theory; QUALITY of life; QUESTIONNAIRES; REGRESSION analysis; SCALE analysis (Psychology); STATISTICS; TALC; TERMINAL care; TERMINALLY ill; THERAPEUTICS; URBAN hospitals; DATA analysis; ACTIVITIES of daily living; PAIN measurement; TREATMENT effectiveness; CHEST tubes; DATA analysis software; FUNCTIONAL assessment; DESCRIPTIVE statistics; PLEURODESIS; KRUSKAL-Wallis Test; VIDEO-assisted thoracic surgery; CANCER treatment
- Publication
International Journal of Palliative Nursing, 2016, Vol 22, Issue 7, p351
- ISSN
1357-6321
- Publication type
Article
- DOI
10.12968/ijpn.2016.22.7.351