An evaluation of a digital health model of care for the management of adults with symptomatic malignant pleural effusion

Specialist ambulatory pleural service (SAPS) model-of-care at Northern Health SAPS will manage participants (n=57) with confirmed malignant pleural effusion based on the treating physicians discretion. Consecutive participants individuals with malignant pleural effusion (MPE) will be offered trial entry and will be enrolled after providing informed consent. Personalized education by the primary physician as part of a standard clinic appointment, pamphlets (on MPE and type of procedure) and Indwelling Pleural Catheter (IPC) consumables (if required) will be provided. The intervention will involve ambulatory aftercare by a treating physician and a pleural nurse. The pleural nurse will visit at home (~ 1 hour), to provide care for the indwelling pleural catheter. At each visit a lung ultrasound will be performed. The ultrasound device used, also enables video calls to be made. The treating physician will view the ultrasound remotely (tele-ultrasound) and do a video call (tele-health) to provide an assessment of the pleural effusion. The visits will occur at days 14 & 28. Months 2, 3, 4, 5 and 6 after which the subject can continue being treated by this model-of-care if they prefer. Being involved also requires completion of a logbook to monitor symptoms for 28 days and participation in surveys at during the routine home visits. Survey questions will include self-evaluating wellbeing, rating how comfortable you are with self-management of your catheter drain, reporting on how easy technology was to use, and rating levels of mobility, self-care, or discomfort. The subject will also be asked about health care outcomes, such as whether they have recently been to hospital or emergency department. Subjects may be selected for an interview via telephone or internet video call that should take approximately an hour. During this interview we will ask about their experience of the care provided by the Specialist Ambulatory Pleural Service: how accessible was the support from Specialist Ambulatory Pleural Service medical/nursing team, and did you find the queries were often answered; how did you find doing the questionnaires: was it burdensome or too frequent; was the education material accessible and understandable. This interview will be performed by an independent clinician trained in interviews for research from outside of Northern Health to reduce bias. Participants will also be given a mobile contact (pleural mobile) which is active 24 hours 7-days a week if there is any worsening of symptoms and troubleshooting of indwelling pleural catheter. Hospital records will be accessed related to hospital admissions, emergency presentations, and outcomes for the purpose of comparing the benefits and risks of this model of care to standard care at other health services. Follow up will continue for 6 months or to death.