Disparities in Access and Use of PleurX Catheters for Treatment of Malignant Pleural Effusion: A Literature and Experience Based Review

Review Data

Q: Is the topic relevant to the journal area of interest? Is it contemporary and interesting for researchers?

Comments: The topic discussed in the manuscript is highly relevant to the field of surgical oncology, as it pertains to the treatment of a common complication in patients with metastatic cancer – malignant pleural effusion (MPE). The use and management of indwelling pleural catheters, such as the PleurX, are an important part of the palliative care provided to patients with advanced-stage malignancies, making this a relevant topic for professionals and researchers in the field of surgical oncology.

This paper addresses an important contemporary issue – disparities in healthcare based on socioeconomic status. By examining the cost and maintenance barriers associated with the use of PleurX catheters, the paper brings attention to potential disparities in the access to and use of this palliative care tool among lower-income patients and those in underserved communities.

In addition, the topic is certainly interesting for researchers as it identifies a gap in current literature – there is a lack of data examining the use of PleurX catheters across socioeconomic strata. This signals an area where further research is needed and could stimulate more studies investigating potential solutions to address these disparities, including health policy interventions or alternative care models.

In summary, this manuscript deals with a contemporary issue that's of significant relevance to surgical oncology and highlights a need for more research in this area. Therefore, it is likely to be of interest to researchers and practitioners in the field.

Abstract & Keywords

Q: Are all required components included in the abstract? Are the keywords appropriately chosen?

Comments: Yes, all required components are included in the abstract. The abstract provides a brief overview of the problem, the reason for investigating this issue, the methods or approach, a summary of the current literature and the authors' experiences, as well as the call for further research on the topic.

The keywords, namely "PleurX catheter", "Malignant Pleural Effusion", and "Access to care" are appropriately chosen.

Goal

Q: Is the goal explicitly stated in the Introduction? Is its formulation clear and unambiguous?

Comments: Yes, the goal of the paper is explicitly stated in the Introduction. The paper aims to investigate whether the cost and maintenance required for tunneled indwelling pleural catheters (IPCs), specifically PleurX catheters, may contribute to health disparities by making them inaccessible to underserved communities.

The formulation is clear and unambiguous, with the introduction providing background information on malignant pleural effusion (MPE) and its treatment, discussing the use of IPCs, and introducing the potential issue of access disparities due to the costs and maintenance demands of these catheters.

Structure

Q: Is the paper's structure coherent? Is it in coherence with the goal of the paper?

Comments: Yes, the structure of the paper appears to be quite coherent and in line with the paper's goal. Here's a breakdown of how the structure supports the goal:

1.     Introduction: The paper begins by providing background information on malignant pleural effusion (MPE) and the use of PleurX catheters. It outlines the potential problem that the cost and maintenance demands of these devices may contribute to health disparities. This sets the stage for the issue the paper seeks to address.

2.     Existing Literature: The paper moves on to discuss current literature related to the cost-effectiveness of MPE treatments and disparities in access to home-health services. This review strengthens the case for the existence of the issue proposed in the introduction.

3.     Our Experience: This section presents anecdotal evidence from a specific healthcare center that aligns with the issue of health disparities proposed in the introduction. This gives a real-world perspective to the problem.

4.     Discussion: This section delves into the problems associated with the current state of affairs and also the limitations of the paper. It's an important section that showcases the implications of the problem and encourages further research.

5.     Conclusion: The paper concludes by summarizing the findings and reiterating the need for further research.

Each of these sections plays an important role in highlighting the disparity issue, which is the goal of the paper, and encourages further exploration of this topic. So yes, the structure is coherent and well-aligned with the paper's goal.

Tools and Methods

Q: Are methods the author uses adequate and well used?

Comments: The methods used in this paper are both adequate and well-suited to the paper's objective, which is largely a narrative review and experiential reflection on the disparities in access and use of PleurX catheters.

The authors employ a literature review to highlight existing knowledge on the use and effectiveness of PleurX catheters, as well as to understand the socioeconomic disparities in healthcare and home health services. This method is adequate for their purpose as it helps them create a context for their argument and establish the knowledge gap in current literature.

The authors also bring in their experiences from a Level 1 trauma center serving an underserved community. This experiential evidence helps them underscore the reality of disparities in the use of PleurX catheters in their own practice, thereby bringing a real-world perspective to the issue.

However, the authors themselves acknowledge that this paper is limited by the fact that it is based on experience from a single center and lacks direct data examining the use of PleurX catheters for MPE across socioeconomic strata. To fully assess the disparities, more comprehensive research would be needed, including quantitative studies across multiple centers and socioeconomic settings.

Nevertheless, for the scope of this review and reflection paper, the methods used are appropriate and have been effectively applied to illustrate the potential issue and to call for further research.

Discussion & Conclusion

Q: Is it related to the results presented before? Do you consider them as coherent?

Comments: Yes, the discussion and conclusion are coherent and directly related to the results presented in the existing literature and the authors' experiences sections.

In the discussion, the authors synthesise their findings from the literature review and personal experience. They identify key barriers such as recurring cost of purchasing drainage kits and access to high-quality home-health nursing that limit access to indwelling catheters, particularly for patients of lower socioeconomic status. They also highlight the implications of these barriers, such as forcing patients and providers to choose less favourable treatment options. The authors also acknowledge the limitations of their paper, which is consistent with good academic practice.

In the conclusion, the authors succinctly summarise the main points of their paper. They reaffirm the benefits of the PleurX tunneled catheter for patients with malignant pleural effusion and emphasize the observed barriers to access in underserved communities. They then conclude with a call for further research into the utilization of PleurX catheters across socioeconomic strata and ways to address the suspected disparity.

Both the discussion and conclusion are grounded in the evidence and arguments presented earlier in the paper, and they provide a clear, coherent summary and interpretation of these points. They successfully tie together the paper's findings and reinforce its main arguments.

Literature

Q: Does the author utilize relevant literature?

Comments: Yes, the authors have utilized relevant literature to support their discussion and argument.

Length

Q: Is the length of the paper adequate to the significance of the topic? Do you suggest shortening the paper without losing its value?

Comments: Given the complexity of the topic, the current length seems appropriate. The authors have efficiently used the space to thoroughly discuss the issue, and it does not seem that any significant portions could be removed without potentially losing valuable information or context.

Writing style

Q: Is it clear and understandable?

A: Yes, the writing style of the paper is clear and understandable. It presents a well-organized flow of ideas from introduction to conclusion, maintaining a professional and academic tone throughout. The language is consistent, and the authors provide logical connections between different sections of the paper.

Furthermore, the authors make good use of citations to support their statements, and their presentation of their own experiences adds a practical dimension to the topic, which increases the comprehensibility and relevance of the paper.

Overall, the writing is coherent, precise, and well-structured, facilitating the reader's understanding of the topic.

Further comments on the paper

Comments:

This paper stands out in several respects:

1.     Relevance and Timeliness: The manuscript addresses an important and understudied issue of disparities in access to health care, focusing on a specific case of PleurX catheter use in the treatment of Malignant Pleural Effusion. This is a highly relevant topic given the ongoing global discussions about health equity.

2.     Evidence-based Approach: The authors present a comprehensive review of existing literature, complemented by their own experiences at University Hospital. This combination of evidence and experiential learning strengthens their argument.

3.     Clarity of Writing: The paper is well-structured and clear, making it accessible to a wide range of readers. The language is professional and academic yet easy to follow. The authors effectively explain medical terminologies and procedures, ensuring that the content is understandable even for readers not intimately familiar with the subject.

4.     Call to Action: The paper does not merely point out the issue but makes a compelling case for further research and potential policy changes. This proactive approach is commendable and necessary for driving real-world changes.

5.     Contribution to Existing Knowledge: Despite the lack of literature directly addressing the use of PleurX catheters in different socioeconomic groups, the authors effectively extrapolate from existing studies on related issues. This innovative thinking enriches the existing knowledge base and opens up new avenues for research.

Overall, this manuscript is a valuable contribution to the ongoing discourse on healthcare disparities and highlights an important area for future research.

Q: Would you recommend this manuscript for further publication?

A: Yes - This manuscript is recommended for further publication

If you have any questions and clarifications you can write to the journal.

Thanks,
Science Repository Team