Introduction Pleural disease is a common health problem in the general population and the number of pleural interventions available to physicians is rapidly expanding. Most clinical studies to date have focused on the generation of successful treatments for pleural diseases without considering patient-centred assessments of symptomatic relief in a procedure undertaken for patient benefit. Patient-related outcome measures (PROMs) such as the assessment of pain and difference in dyspnoea have been used in other disease areas to estimate effectiveness and guide interventions. This prospective study measured PROMs after pleural interventions using a specific survey questionnaire.
Methods Data were collected from 95 patients treated in a tertiary referral centre from December 2013 to June 2014. Pleural interventions included diagnostic aspiration, therapeutic aspiration, thoracoscopy, intercostal chest drain insertion and indwelling pleural catheter insertion. We gathered information on pain, dyspnoea, expected improvement and willingness to repeat the procedure if needed using a 100 mm visual analogue scale (VAS). Clinical, radiological and histological data were recorded and categorised the patients with pleural effusions to either: malignant, infected, heart failure and undiagnosed. Patients with pneumothorax were classified to either primary or secondary. Data are presented as mean ± SD.
Results Data were collected from 31 therapeutic aspirations, 30 intercostal drain insertions, 17 diagnostic/simple aspirations, 14 thoracoscopies and 3 indwelling catheter insertions. The results showed the procedure associated with the most pain is medical thoracoscopy (VAS: 20 ± 20.3 mms) whereas diagnostic aspiration (VAS: 2.52 ± 4.78 mms) was the least uncomfortable. Pain measurements were similar in intercostal and indwelling pleural catheter insertion groups (p: 0.75). VAS score for dyspnoea demonstrated that intercostal drain insertion had the greatest effect on patients’ breathlessness compared to the other procedures (VAS difference pre and post-procedure: 50.8 ± 27 mms).99.8% of the patients would repeat any of the pleural procedures if needed.
Conclusion Our study, the first to prospectively assess patient-related outcomes in pleural procedures, demonstrates that different pleural procedures significantly improve symptoms alongside a high degree of patient satisfaction. Pleural PROMs may represent a standardised way of measuring symptomatic benefit which can be used in both clinical practice and future research.