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: ISRCTN44504648.

Keywords: chemotherapy; interventional radiology; oncology; qualitative research.