Introduction
The current pathway in suspected malignant pleural effusion involves multiple procedures to achieve diagnosis and fluid control, typically  1)pleural aspiration 2)biopsy and 3)Indwelling pleural catheter. The patient experience of this pathway is unexplored.

Methods
Patient records were reviewed to establish pathway duration. Semi structured qualitative interviews were undertaken with 17 patients at IPC insertion.

Results
56 patient records were reviewed. Median time to 1)diagnosis was 46 days (IQR:28-54) and 2)time to fluid control was 70 days (IQR:45-84).

17 patients (10 male, 7 female) were interviewed.
 
Breathlessness 'limiting daily activities' was a common complaint. 65% (11/17) of patients reported ?1 month of breathlessness, with 88% (15/17) stating impact on daily activity. 35% (6/17) reported an 'unacceptable' duration of breathlessness.

60% (11/17) of patients reported making ?1 emergency call for fluid drainage or admission, with comments pertaining to ?being too breathless to wait?. 76% (13/17) had undergone ?2 pleural procedures prior to IPC insertion.

70% of patients (12/17) reported a preference for earlier IPC and all patients provided input on a proposed feasibility study of early pleural biopsy+IPC.

Conclusions

The current MPE pathway is lengthy with multiple procedures. Using this study we have designed the STREAMLINE trial to assess pleural biopsy + IPC as a 1st procedure vs standard care in suspected MPE.