OBJECTIVES:

The primary objective of this research was to incorporate patient perspectives into a large-scale trial (Cancer and Venous Access; CAVA) comparing the safety and effectiveness of three venous access devices for the delivery of chemotherapy (Hickman type device, PICC, implantable chest-wall Port).

Secondary objectives included the assessment and development of a quality of life measure for patients using these devices, and to inform the education of clinicians caring for these patients.

METHODS:

Semi-structured focus group discussions were conducted with patients at six sites in England and Scotland participating in CAVA. Focus groups were audio-recorded, transcribed, and data were analysed using thematic analysis. A range of experiences with different devices were sampled.

RESULTS:

Four key themes were identified.

(i) Patient adaptability: Overall, patients found that the devices had limited impact on their daily lives. However, the minimisation of impact depended on patients making adaptations and adjustments to behaviour and routines.

(ii) Positive psychological aspects of Ports: Patients had positive perspectives on all devices. Patients with Port devices discussed additional social and psychological benefits.

(iii) Staff capabilities influence patient experiences: Patients’ concerns about their devices were tied to perceptions regarding staff confidence/competence. Patients with Ports described playing a role in educating staff unfamiliar with the device.

(iv) Measurement of quality of life: Patients provided feedback on an original questionnaire developed for the purposes of CAVA which was felt to capture experiences more adequately than a standardised measure (i.e., EQ-5D).

CONCLUSIONS:

This research identifies several challenges facing patients who need CVADs for the administration of chemotherapy, and offers novel insights regarding some potential benefits of Ports. It also suggests that conventional approaches using EQ-5D alone to capture the impact of medical devices on patient quality of life may not be sufficient; the incorporation of technology-specific measures should be considered.