Abstract
Background: Within many hospitals the procedure of talc slurry instillation to induce pleurodesis for the management of malignant pleural effusions is traditionally undertaken by physicians. There are inconsistencies with the way in which the procedure is carried out, which are said to affect the success of the procedure (Tan et al 2006). It is suggested that appropriately trained nurses could competently perform this procedure as safely and effectively as doctors. The null hypothesis is that there is no difference in patient satisfaction when the procedure is performed by doctors or nurses. Methods: This was a prospective, randomised, non-inferiority, multi-centre pilot study. Between February 2006 and December 2006, 20 patients were randomised from four centres to have talc pleurodesis carried out either by a nurse or a doctor. The primary outcome measure was patient satisfaction. Secondary outcome measures included complications, pain and anxiety levels, recurrence of effusion at one month and impact of the procedure on workload and professional development. All staff were required to undertake a period of training, and the same assessment criteria were applied to both doctors and nurses. Results: 17 patients were included in the final analysis (9 male, 8 female). All patients had a malignant pleural effusion due to adenocarcinoma, mesothelioma or breast cancer. Three patients were excluded from the analysis; two patients did not have the procedure performed and one patient did not have the procedure performed according to the group allocation. Patients in both groups reported that they were satisfied with the care they had received from the person performing the procedure. There was no significant difference in pain or anxiety assessments between the groups. Recurrence of effusion was observed in two patients, one patient from each group. One patient required prolonged hospitalisation for reasons not related to the talc pleurodesis. Conclusion: The results from this study to date imply that nurses are as safe and effective as doctors in performing this procedure and that patients are as equally satisfied with nurses as they are with doctors. Although the small sample size does not allow us to detect a significant difference between doctor and nurse led procedure, the data does suggest that this is a procedure which can be competently and safely undertaken by appropriately trained nurses. Recruitment to the study is continuing until 40 patients are enrolled.