Patient acceptability of three different central venous access devices for the delivery of systemic anticancer therapy: a qualitative study

Abstract

Objective Three types of central venous access devices (CVADs) are routinely used in the delivery of intravenous systemic anticancer therapy (SACT): peripherally inserted central catheters (PICCs), subcutaneously tunnelled central catheters (Hickman-type devices) and totally implantable chest wall ports (Ports). This qualitative study, nested within a multicentre, randomised controlled trial, sought to explore patient acceptability and experiences of the three devices. Design Eight focus groups were audio-recorded, transcribed and thematically analysed. Setting Six outpatient cancer treatment centres in the UK. Participants Forty-two patients (20 female, mean age 61.7 years) who had taken part or were taking part in the broader trial. Intervention As part of the larger, randomised controlled trial, participants had been randomly assigned one of three CVADs for the administration of SACT. Results Attitudes towards all three devices were positive, with patients viewing their CVAD as part of their treatment and recovery. Participants with PICCs and Hickmans tended to compare their device favourably with peripheral cannulation. By comparison, participants with Ports consistently compared their device with PICCs and Hickmans, emphasising the perceived superiority of Ports. Ports were perceived to offer unique psychological benefits, including a greater sense of freedom and less intrusion in the context of personal relationships. Conclusions Patient experiences and preferences have not been systematically used to inform policy and practice regarding CVAD availability and selection. Our research identified patterns of patient device preferences that favoured Ports, although this was not universal. Results of this study could improve support for patients and offer greater scope for incorporating patient perspectives into decision-making processes. Trial registration number NCT44504648

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

“…In the present study, skin tunnelled catheters were reported by parents and adolescents to require more self-management than totally implanted ports because of the need for regular dressing changes, cleaning and flushing of the lines, and maintaining the cleanliness of the access port and clamps to avoid infection. These findings reflect those found amongst an adult population with central venous access devices ( Ryan et al., 2019 ). Participants in the present study tended to accept the care requirements of a skin tunnelled catheter without much complaint, and none was in a position to compare this with managing a totally implanted port which, because of its embedded position under the skin, required considerably less management.…”

“…The adolescents with totally implanted ports and their parents were very positive about the freedom to engage fully in everyday life that an implanted port offered. This freedom has been previously documented in literature on central venous access devices amongst child ( Mangum et al., 2013 ) and adult populations ( Ryan et al., 2019 ; Ivziku et al., 2022 ).…”

“…If we turn to the experiences of those with a central venous access device more generally, totally implanted ports are recognised as having clear advantages over other devices; they are less noticeable, allow for more freedom of movement without the risk of accidental dislodgement, as well as freedom for certain activities such as showering/bathing and swimming ( Gallieni et al., 2008 ; Johansson et al., 2009 ; Ryan et al., 2019 ). By contrast, external venous catheters are more noticeable, and the dressing over the access point and lumen must be kept clean and dry to avoid the risk of infection which decreases freedom to engage in many activities ( Wagner et al., 2011 ; D'Souza, 2014 ; Ivziku et al., 2022 ).…”

Supportive care needs of adults living with a peripherally inserted central catheter (PICC) at home: a qualitative content analysis

“…Most participants faced practical challenges, especially adapting showering to keep the PICC dressing dry in the shower. Many of the practical challenges and supports required to adapt daily life support previous research that has documented the experience of people with a PICC [ 9 , 10 , 12 , 13 , 15 , 19 ]. Participants also raised other practical challenges they faced, such as modifying exercise, parenting, and sexual relationships which have not been identified previously.…”

“…Both cohorts have reported that adapting usual tasks, such as showering, to prevent complications [ 9 – 14 ]. Similarly, individuals receiving treatment for cancer and infection with a PICC have indicated that they felt underprepared for life with the device and described challenges understanding PICC information [ 11 , 12 , 15 ]. Research in both cohorts has found that some people face psychological challenges with accepting the PICC, as well as perceived stigma from the device, resulting in a need to conceal the PICC from view [ 10 , 16 , 17 ].…”