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Ascitic Drainage in Dying Phase — SCE Palliative Medicine MCQ

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ModerateEnd of Life CareAscitic Drainage in Dying PhaseSCE Palliative Medicine

A 55‑year‑old woman with advanced ovarian cancer has refractory malignant ascites requiring frequent drainage. She has a tunnelled peritoneal drain in situ and is now entering the dying phase. What is the most appropriate decision at this stage?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Decide whether to continue or stop drainage—continue if it provides symptom relief and remains tolerable, otherwise cease.

Explanation lettering: C = shown as A · D = shown as C · A = shown as D

Option A is correct. NICE’s guidance on PleurX/peritoneal catheter systems supports their use in malignant ascites to improve quality of life and reduce hospital visits in palliative settings. Decision-making should remain dynamic and guided by symptom benefit versus intervention burden. Options B and C are inappropriate: increasing frequency without symptom benefit or switching to diuretics in refractory malignant ascites are not evidence‑based. Option D is unnecessary: tunnelled drains are safe and removal is not required unless complications arise. Option E disregards the potential for ongoing symptom control in the dying phase. The stem’s context clearly directs towards a nuanced, patient-centred approach.

Reference: NICE MTG guidance on PleurX/peritoneal catheter for malignant ascites (HTG282, 2022); Right Decisions Scotland malignant ascites guideline (2025)