Adult oncology patients' experiences of living with a central venous catheter: a systematic review and meta-synthesis

Patient reported outcome and experience measures among patients with central venous access devices: a systematic review

PURPOSE

Patients receiving treatment for solid tumours and haematological malignancies, among other acute and chronic health conditions, are highly dependent upon central venous access devices (CVADs) for administering chemotherapy and other complex therapies; thus, CVADs can meaningfully impact their health outcomes and experiences. This systematic review aimed to identify and critique patient-reported outcome measure (PROM) and patient-reported experience measure (PREM) instruments related to CVADs.

METHODS

A systematic review was undertaken, commencing with an electronic search of health databases (April 2022). Studies were eligible if they used a self-reporting instrument (questionnaire) to quantitatively measure patient-reported outcomes and experiences related to CVADs (English only). Using a piloted data-extraction tool, two authors independently identified studies for full review, data extraction, and quality assessment. Data were synthesised narratively.

RESULTS

The search yielded 875 titles, of which 41 met the inclusion and no exclusion criteria. Of these, 31 reported results of purpose-built questionnaires; a further six reported results of generic measures used for CVADs; four included both purpose-built and generic measures. Overall study quality was low; only two studies evaluated both content validity and internal consistency. In total, 155 unique PROM items (across 27 studies) were extracted which encompassed five domains (e.g., 'Instrumental activities of daily living'; 'Pain and discomfort'). Similarly, 184 unique PREMs (from 31 studies) included 13 domains (e.g., 'Shared decision-making'; 'Education').

CONCLUSION

Increasingly, research and quality improvement studies about CVADs are incorporating PROM and PREM. These measures are largely purpose-built, however, and their validity and reliability have not been sufficiently established for use.

REVIEW REGISTRATION

Prospectively submitted to the International prospective register of systematic reviews (PROSPERO) 05 July 2020.

Cancer patients' experience with implanted venous ports: A qualitative descriptive study

AIM

The aim of this study was to explore the experiences of cancer patients regarding venous access ports.

BACKGROUND

The utilization of intravenous access ports for administering chemotherapy drugs is on the rise. Understanding patients' experiences with these devices can provide valuable insights for nursing managers and nurses.

METHODS

A conventional qualitative content analysis approach was employed to explore the experiences of 14 patients who had venous access ports. The participants were selected from patients admitted to the oncology ward of a hospital affiliated with Kermanshah University of Medical Sciences. A purposive sampling method was used for participant selection. Semi-structured in-depth interviews were conducted as the data collection tool. MaxQda-10 software was utilized for data management.

RESULTS

The data analysis yielded three main categories and ten sub-categories. The categories consisted of positive aspects of venous access ports, negative aspects of venous access ports, and barriers to accepting venous access ports.

CONCLUSIONS

The participants highlighted both the positive and negative aspects of venous access ports, while also identifying insufficient knowledge and "fear and anxiety" as barriers to accepting these devices. Providing essential training and offering psychological support to newly hospitalized cancer patients could prove beneficial in this regard.

Multi-professional development of a competency framework for patients with a Port-a-Cath (PAC)

PURPOSE

In France, 40,000 Port-a-Cath (PAC) are inserted each year. These medical devices are prone to complications during their insertion or use. The education of patients wearing these devices could be a lever to reduce the risk of complications. The objective of this work was to develop, in a multi-professional and consensual manner, a unique and specific skills reference framework for patients with PAC and to propose it as a reference tool for health professionals.

METHODS

A multidisciplinary working group was set up to draw up this reference framework of skills. The first stage of the work consisted of a reflection leading to an exhaustive list of competencies necessary for the patient. These skills were then classified according to three different fields of knowledge (theoretical, know-how and attitudes). Finally, the working group identified priority competencies and established a grid that can be used to evaluate the level of acquisition of these competencies.

RESULTS

Fifteen competencies were identified: five relating to theoretical knowledge, six relating to know-how and four relating to attitudes. These competencies were broken down into sub-competences. Seven competencies or sub-competencies were selected to constitute the list of priority competencies.

DISCUSSION

This competency framework provides a reference framework for the education of patients with PAC and will help to harmonise practices within the different teams that care for patients with PAC.

The experiences of adolescents living with a central venous access device: A qualitative analysis

Background

Central venous access devices are used in paediatric populations for specific chronic conditions requiring long-term treatment. Very little isknown about how young people experience living with such devices.

Aim

To gain a deep understanding of adolescents' (aged 12-17 years) experiences of living with a central venous access device from the perspective of the adolescents themselves, and of one of their parents.

Design

A descriptive phenomenological design was chosen.

Methods

The sample comprised 20 participants, 10 adolescents with a central venous access device who were purposefully selected from a paediatric unit in Ireland, along with one of each adolescent's parents. Five of the adolescents had a skin tunnelled catheter that partly sits outside the body; and five a totally implanted port contained within the body. Participants were interviewed in adolescent-parent dyads, and data were analysed using an established phenomenological method.

Results

Findings are presented around three themes: (i) The process of receiving treatment; (ii) managing skin tunnelled catheters and totally implanted ports day-to-day; and (iii) activities of daily living with a skin tunnelled catheter or a totally implanted port. Participants tended to compare their current device with previously negative experiences of multiple needle punctures associated with peripheral cannula insertions. Participants were largely positive about the type of device the adolescent currently had. However, in terms of daily management of the device itself and engaging in daily activities, totally implanted ports were more favourable than skin tunnelled catheters. Participants with a totally implanted port tended to minimise the needle-stick experience to access to the totally implanted port's reservoir.

Discussion

Findings from the present study on adolescents concur with those of previous studies on adults that found that individuals with a central venous access device were largely positively disposed to their device and tended to compare their experiences of it to previously negative experiences with peripheral cannula insertions. Findings also reflect existing research that has reported a favourable disposition to self-management of a central venous access device, and a greater freedom to engage in everyday activities for those with a totally implanted port compared to those with a skin tunnelled catheter.

Conclusion

We conclude that the type of central venous access device may have a pervasive and important impact on the everyday lives of adolescents and this needs to be given appropriate weight in formal guidelines for clinicians.