Introduction For patients with known malignancy, development of malignant pleural effusion (MPE) is a poor prognostic marker: median survival with effusion at presentation is five months (Zamboni et al., 2015), but for the majority of those developing MPE during active cancer management, prognosis is much worse.
Management of pleural fluid in this setting should be individualised, depending on symptoms, functional status, prognosis and fully informed patients preferences. Pleural drainage whether single aspiration, short term drain or semi-permanent drain are all highly invasive procedures with risks attached.
Locally, patients developing MPE were frequently referred to the respiratory service for insertion of an indwelling drain inappropriately (either too unwell, or single drainage preferable, or without understanding their prognosis) and were often not known to palliative care services.
Aim To create a pathway ensuring patients developing MPE had a holistic palliative care assessment and creation of an effusion management plan appropriate to their symptoms, prognosis and informed preferences.
Method Patients developing MPE are referred to the respiratory consultant and advised they will have a palliative care review as part of the assessment process. A hospice palliative care CNS who has undertaken additional training on assessing these patients, visits at home within five days – assesses palliative care needs, discusses prognosis and options for management (semi-permanent drain/single drainage/medical management of breathlessness) with patient/family. If drainage is appropriate, the palliative care CNS liaises with the respiratory team and the patient is booked in, as well as arranging on-going palliative care support.
Results Patient and staff satisfaction results will be available at conference, along with the first six months of data from the pathway.
Conclusion Collaboration between specialties and between services can ensure patients receive timely assessment of needs and are fully informed in order to make choices about potentially invasive interventions.
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