Design and validation of a self-administered questionnaire as an aid to detection of occupational exposure to lung carcinogens

Our plain-English summary of Design and validation of a self-administered questionnaire as an aid to detection of occupational exposure to lung carcinogens, by C. Pélissier, V. Dutertre, P. Fournel, et al (Public Health, 2017).

The study

• Authors: C. Pélissier, V. Dutertre, P. Fournel, I. Gendre, J. Michel Vergnon, J. Kalecinski, F. Tinquaut, L. Fontana, F. Chauvin
• Journal: Public Health
• Published: 2017;143:44-51
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: Ten to thirty percent of lung cancer is thought to be of occupational origin. Lung cancer is under-declared as an occupational disease in Europe, and most declarations of occupational disease concern asbestos. The purpose of this study was to design and validate a short, sensitive self-administered questionnaire, as an aid for physicians in detecting occupational exposure to asbestos and other lung carcinogens in order to remedy occupational lung cancer under-declaration.

Study Design: Cross-sectional study.

Methods: A short (30-question) self-administered questionnaire was drawn up by oncologist-pneumologists and occupational physicians, covering situations of exposure to proven and probable lung carcinogens. Understanding and acceptability were assessed on 15 lung cancer patients. Validity and reliability were assessed on 70 lung cancer patients by comparison against a semi-directive questionnaire considered as gold standard. Sensitivity and specificity were assessed by comparing responses to items on the two questionnaires. Reliability was assessed by analysing the kappa concordance coefficient for items on the two questionnaires.

Results: Sensitivity was 0.85 and specificity 0.875. Concordance between responses on the two questionnaires was 85.7%, with a kappa coefficient of 0.695 [0.52-0.87]. Mean self-administration time was 3.1 min (versus 8.12 min to administer the gold-standard questionnaire). In 16 patients, the self-administered questionnaire detected lung carcinogen exposure meeting the criteria for occupational disease.

Conclusion: The present short, easy-to-use self-administered questionnaire should facilitate detection of occupational exposure to lung carcinogens. It could be used in occupational lung cancer screening and increase the presently low rate of application for recognition of lung cancer as an occupational disease.

Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

In plain English

This cross-sectional study at two French centres tested a questionnaire that lung cancer patients fill out themselves. It flags possible past work exposure to lung carcinogens, including asbestos; 'don't know' counted as positive. The first version had 29 questions, 10 on asbestos; two were combined after a 15-patient trial. Then 70 patients completed it and a longer reference ('gold standard') questionnaire. Against the reference, sensitivity was 0.85 and specificity 0.875. The two agreed 85.7% of the time (kappa 0.695, bracketed range 0.52 to 0.87), which the authors called moderate reliability. For asbestos, 41 patients were flagged on the new questionnaire and 43 on the reference (sensitivity 0.837, specificity 0.815). It took 3.1 minutes on average, versus 8.12 for the reference. The article reports 38 patients positive on at least one exposure question but does not reconcile this with the 41 flagged for asbestos. An occupational physician judged that 16 met all French occupational disease table requirements and advised applying; outcomes of applications were not reported. The authors concluded it could be used to screen lung cancer patients for a possible occupational origin.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cross-sectional study designing and validating a self-administered questionnaire against a semi-directive 'gold-standard' questionnaire (SLFP/SFMT)
• Who was studied: Volunteer patients with primary lung cancer treated at the Saint-Etienne University Hospital Center and the Lucien Neuwirth Cancer Institute, France. There were 15 in the pre-test and 70 in the test phase (49 male, 21 female; 52, or 74.3%, with stage IV disease). Dates of the study are not given.
• Exposure: Possible past occupational exposure to lung carcinogens listed in French occupational disease tables. The first version had 29 questions: 10 on asbestos, 4 on arsenic, 1 on bis(chloromethyl) ether, 2 on chromium derivatives, 5 on polycyclic aromatic hydrocarbons, 1 on nickel derivatives, 1 on radioactive dust or gas, 1 on iron-mining, 2 on cadmium and 1 on crystalline silica. After the pre-test, two questions were combined. The abstract describes a 30-question questionnaire.
• Main results:
  • Overall, compared with the gold-standard questionnaire, the self-administered questionnaire had a sensitivity of 0.85 and a specificity of 0.875 (70 test-phase patients).
  • Overall agreement between the two questionnaires was 85.7%, with a kappa coefficient of 0.695 (bracketed range 0.52 to 0.87), described by the authors as moderate reliability.
  • For asbestos, 41 patients (58.6%) were positive on the self-administered questionnaire and 43 (61.4%) on the gold standard. Concordance was 82.9%, kappa 0.64 (0.46 to 0.83), sensitivity 0.837 and specificity 0.815.
  • Among patients with possible asbestos exposure on the self-administered questionnaire, 22 (54.0%) had worked in construction and civil engineering, 16 (39.0%) in manufacture or sale of asbestos-containing articles, and 14 (34.0%) had used asbestos-based materials.
  • Mean completion time was 3.1 minutes for the self-administered questionnaire, compared with 8.12 minutes for the gold-standard questionnaire.
  • The article states that 38 of the 70 patients answered positively to at least one exposure question. This is fewer than the 41 patients it reports as positive for asbestos alone on the self-administered questionnaire, and the article does not explain how the two counts relate.
  • The occupational physician's assessment of those 38 patients was as follows. In 16, all occupational disease table requirements were met and an application was advised and considered very likely to be accepted. In 13, an application was advised with a greater risk of refusal. In 9, an application was not advised. The outcomes of any applications are not reported.
• The authors' conclusion: The authors concluded that the short, easy-to-use self-administered questionnaire was designed and validated to help identify occupational lung carcinogen exposure. They said it could be used to screen for lung cancer of occupational origin and could increase the low number of applications for recognition as an occupational disease.
• Limitations the authors state:
  • Kappa, sensitivity and specificity could not be reliably determined for bis(chloromethyl) ether, nickel derivatives, radioactive dust, cadmium, polycyclic aromatic hydrocarbons or crystalline silica, because few patients reported these exposures.
  • The study did not examine how the questionnaire would be given to patients within routine care.

Topics

Medical terms in this study, explained in our Lexicon: Occupational Exposure, Lung Cancer, Occupational Disease, Low-Dose CT Screening.

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