This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Carol Tan Tom Treasure Martin Utley Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tan, C. Articles by Hemingway, H. Search for Related Content PubMed PubMed Citation Articles by Tan, C. Articles by Hemingway, H. Related Collections Pleura

Appropriateness of VATS and bedside thoracostomy talc pleurodesis as judged by a panel using the RAND/UCLA appropriateness method (RAM)

^a Thoracic Unit, Guy's Hospital, St Thomas' Street, London SE1 9RT, UK
^b Health Services Research Unit, London School of Hygiene and Tropical Medicine and Clinical Effectiveness Unit, Royal College of Surgeons of England, Keppel Street, London WC1E 7HT, UK
^c Clinical Operational Research Unit, UCL, London WC1E 6BT, UK
^d Royal Berkshire Hospital, Reading, Berkshire, RG1 5AN, UK
^e Department of Epidemiology, UCL, London WC1E 6BT, UK

*Corresponding author. Tel: +44 20 7188 1034; fax: +44 20 7188 1016.

E-mail address: Tom.Treasure{at}gstt.sthames.nhs.uk; tom.treasure{at}ukgateway.net (T. Treasure).

We sought formal consensus on the appropriateness of Video-assisted Thoracoscopic Surgery (VATS) talc pleurodesis and bedside thoracostomy talc slurry by use of a well established method – the RAND/UCLA appropriateness method (RAM). We recruited an expert panel of respiratory physicians, oncologists, and surgeons under the leadership of experts in health services research. The panellists were provided with evidence from a systematic review and then were taken through two rounds of opinion gathering, the first individually, the second as a group. The purpose is not to force consensus, but to find scenarios where there is agreement on the appropriateness or inappropriateness of a treatment and scenarios where there is disagreement. In scenarios where the diagnosis was proven and expectation of life beyond six months, pleurodesis was deemed appropriate. If there was no tissue diagnosis surgical VATS was preferred. The response to a trial aspiration played a major part in the recommendation for or against pleurodesis. The attitude to breathlessness was incongruous; it is the target of palliation yet some interpreted it as performance status and thus a contraindication. Although the RAM is well developed and in widespread use, we found it worryingly unreliable and to be used with caution.

Key Words: Malignant effusion; Pleurodesis; Talc; Rand appropriateness method; Consensus method

This article has been cited by other articles:

				C. Tan, T. Treasure, J. Browne, M. Utley, C. W H Davies, and H. Hemingway Seeking consensus by formal methods: a health warning J R Soc Med, January 1, 2007; 100(1): 10 - 14. [Full Text] [PDF]