Introduction Malignant pleural effusion (MPE) management has dramatically changed in the last decade with the increasing use of indwelling pleural catheters (IPC) and thoracoscopy. Although treatment is aimed at improving health related quality of life (HRQOL), data on outcomes are limited, with management guided by clinician perspectives and experiences.
Aims We sought clinician perspectives of HRQOL for patients with MPE and its impact on decision making worldwide. We present the UK data.
Methods We invited all respiratory doctors in the UK to complete an online survey advertised in the British Thoracic Society newsletter and by e-mail. Responses to questions with ranked options were assigned consecutive integers with lower values indicating a more favoured or higher prioritised response. Responses to best answer questions are presented as frequencies and percentages.
Results 121 UK-based doctors (104 consultants, 1 associate specialist, 16 respiratory registrars) completed the survey.
Factors determining HRQOL (rank 1–9): shortness of breath and chest pain (mean rank 1.48) and functional status (mean rank 2.57) were ranked the most important. Social set up – mean rank 5.16, depression/anxiety – mean rank 5.22, tumour type and stage – mean rank 5.78, distance to travel for medical care – mean rank 5.86, age – mean rank 6.59, financial difficulties from treatment – mean rank 8.27.
Factors in the decision to offer intervention for MPE (rank 1–6): breathlessness ranked highest (mean rank 1.83) followed by the risk of significant harm from procedure vs chance of benefit (mean rank 2.73).
Perspectives on which interventions most improve HRQOL are presented in Figure 1.
Conclusion Shortness of breath and chest pain ranked highly in the perspective of HRQOL with shortness of breath a key factor in offering intervention. There is a lack of consensus on the ideal treatment to maximise HRQOL, which may reflect the paucity of data. Robust clinical trial evidence on HRQOL outcomes is therefore required to guide management decisions of patients with MPE. This should be complemented by a patient survey to ascertain differences in clinician and patient perspectives of quality of life and care.
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