Qualitative insights into patient and carer perspectives of malignant pleural effusion management: an embedded study within the TACTIC trial.

Abstract

Background: Malignant pleural effusion (MPE) is a condition characterised by excessive fluid build-up in the pleural cavity caused by cancer. Management options focus on drainage of fluid from the pleural cavity with a common aim of minimising symptoms and improving quality of life. Definitive pleural intervention is recommended for most patients with MPE to achieve longer-term symptom control. A patient-centred approach is also emphasised. However, little is known about the patient and carer experiences of MPE management. Therefore, this study sought to examine patient and carer experiences of differing procedural interventions within a trial setting.

Methods: Patients with MPE and their carers who were taking part in the TACTIC trial in hospitals across the UK were invited to take part in a one-off interview. Thirty-two participants were recruited, and 22 semistructured interviews were conducted. Interview formats were either patient only, carer only or patient and carer dyad interviews. Interviews were audio recorded, transcribed verbatim and analysed using a generalised thematic analysis approach.

Results: Initial findings demonstrated that patients and carers were generally satisfied with the MPE management and care received. No significant differences in acceptability were found between the two management strategies. Further analysis led to the development of four overarching themes: experiences of MPE beyond the trial, experiences of pain, preferences in MPE care and measuring MPE: rethinking patient relevance. These findings underscore the importance of greater consideration of pain management during MPE care, as well as improved communication and information prior to procedures.

Conclusion: Patients and carers found the TACTIC combined procedure tolerable and acceptable. Echoing the growing evidence of research in this field, authors emphasise the importance of outcome measure selection in MPE trials and suggest a need for a Core Outcome Set to establish fundamental priorities in MPE management.