Indwelling Pleural Catheters: a Self-management Intervention
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- This is an observational study: the protocol does not assign a study treatment.
- Who it may be relevant to
- Registry conditions: Indwelling Pleural Catheter. Basic parameters: from 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- United Kingdom
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
Unsure about the terms? Read our patient guide →
Official title
Indwelling Pleural Catheters: Co-developing an Intervention to Support Self-Management
Overview
A pleural effusion is a build-up of fluid around the lung. In the UK, about quarter of a million people develop a pleural effusion each year. They are usually caused by advanced cancer or heart, kidney, or liver failure. People with a pleural effusion feel breathless and can't do the things they want to. Draining the fluid improves breathlessness and quality of life. This can be done by inserting a semi-permanent tube called an indwelling pleural catheter (IPC). This is drained at home about three times a week. Drainage is usually done by a community nurse. However, it can be done by the patient or family/unpaid carers - this is called self-management. Self-management gives the patient the freedom to drain their IPC when they need to, without having to wait at home until a nurse is available. It reduces the burden on community nursing services. Despite these benefits, not all patients get the opportunity to self-manage. The aim of this study is to help more patients self-manage if they want to. We will achieve this through three stages: Stage 1: We will talk to patients with IPCs as well as their families/carers to find out their views on self-management and what stops people who could self-manage from doing so. We know that patients with an IPC can be frail. Often their families/carers are already doing a lot to support them. We will ask what might help them to self-manage if they would like to. Stage 2: We will talk to healthcare professionals (HCPs) looking after patients with IPCs to understand what they think about self-management. This will include community nurses and the hospital teams who put IPCs in. Stage 3: Along with our patients, their families/unpaid carers and HCPs, we will hold workshops to design an intervention that will help people to self-manage IPCs. We don't know what this intervention will look like yet. From talking to patients and families who already self-manage, we have found they like to learn from a demonstration on their own IPC followed by supervised self-management until they feel confident. Therefore, our intervention may include training sessions for HCPs on how to teach self-management. This study grew from conversations with our patients. People with an IPC, family members and community nurses helped design the study. Our patient and public involvement (PPI) group will help design study materials and guide the study.
Detailed description
Research question:
How can patients with an indwelling pleural catheter (IPC) and their family/unpaid carers be supported to self-manage?
Background:
Pleural effusion is the accumulation of fluid in the space between the lung and chest wall. It is a common complication of malignancy and affects approximately 200-250,000 people annually in the UK. People with such an effusion experience disabling breathlessness; this is treated by draining the fluid using IPCs (semi-permanent chest drains). These are usually managed at home by community nurses, but this can be done by the patient, family member or carer. Supported self-management is part of the NHS long term plan and British Thoracic Society guidelines state that patients should be supported to self-manage their IPC to promote independence. However, there is no evidence to support these recommendations, nor guidance on how self-management should be facilitated. There is thus an evidence gap at the heart of current recommendations.
Objectives:
O1. Identify support needs of patients with IPCs and their family/unpaid carers and how these impact on the acceptability and feasibility of self-management.
O2. Identify barriers and motivators to IPC self-management among patients and family/unpaid carers.
O3. Understand healthcare professional (HCP) attitudes toward, and practices related to, IPC self-management.
O4. Co-design and develop an evidence-based intervention to facilitate IPC self-management.
Methods:
An applied qualitative study and co-design project comprising three stages mapped to the four objectives.
S1: semi-structured interviews with patients with an IPC and their family/unpaid carers regarding self-management and support needs.
S2: focus groups and interviews with community nurses and IPC service staff regarding self-management.
S3: co-design and development of a self-management intervention.
Interviews will be audio- or audiovisual-recorded (with permission), transcribed, and analysed using thematic analysis. Codes will be assigned to text to categorise meanings. Given the lack of prior research, the coding schema will be developed inductively from early transcripts (with reference to literature from other fields), refined and applied to subsequent transcripts. Codes will be categorised, themes identified, and the results developed into a narrative. The COM-B system will be the model of reference for the development of the self-management intervention. This is comprised of a behaviour change wheel linked to intervention functions and policy categories.
Inclusion criteria Stage 1 - patients and family/unpaid carers
* Adult (\>18 years) who has (or has had) an IPC OR * Adult family member or unpaid carer of a patient who has (or has had) an IPC * Patients may currently be self-managing or receiving CN care. Stage 2 - healthcare professionals * Community nurse: experience of caring for a patient with an IPC within the last 12 months and signed-off as competent in IPC management * IPC-insertion site staff: any HCP involved in discussion with patients about post-insertion IPC care Stage 3 - co-design groups * as above
Exclusion criteria Stage 1 - patients
* Patient with a life expectancy of less than 6 weeks * Patient or family/unpaid carer who lacks capacity to offer informed consent (as judged by a suitably qualified HCP in accordance with Good Clinical Practice guidelines) Stage 2 - Health care professionals * None Stage 3 - co-design groups * As above
Anticipated Impact and Dissemination
The principal output will be a prototype self-management intervention for patients with an IPC and their family/unpaid carers that will:
* Empower patients, increase perceived symptom control, and reduce time spent 'waiting in' for nursing visits; * Relieve pressure on community nursing services and reduce healthcare costs; * Support the NHS long term plan by enabling supported self-management; * Facilitate more frequent drainage which may prevent re-accumulation of pleural fluid.
Primary outcome measures
- Capturing Health Care Professionals attitudes toward and beliefs about self-management [Time frame: Periprocedural]
Eligibility criteria
Inclusion criteria
- Stage 1 - Patients and family/unpaid carers
- Adult (>18 years) who has (or has had) an IPC OR
- Adult family member or unpaid carer of a patient who has (or has had) an IPC
- Patients may currently be self-managing or receiving CN care.
Stage 2 - Healthcare professionals
- Community nurse: experience of caring for a patient with an IPC within the last 12 months and signed-off as competent in IPC management
- IPC-insertion site staff: any HCP involved in discussion with patients about post-insertion IPC care
Stage 3 - Co-design groups
o as above
Exclusion criteria
- Stage 1 - Patients
- Patient with a life expectancy of less than 6 weeks
- Patient or family/unpaid carer who lacks capacity to offer informed consent (as judged by a suitably qualified HCP in accordance with Good Clinical Practice guidelines)
Stage 2 - Health care professionals o None
Stage 3 - Co-design groups
o As above
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Observational model
- Other
Study locations
United Kingdom · 1 center
- Norfolk and Norwich University Hospitals NHS Trust — Norwich
Identifiers
NCT: NCT06910800 · Pac-man protocol | v1.0 | 14.0 · 333923 · 58382