Inequities in reporting asbestos-related lung cancer: influence of smoking stigma and physician's specialty, workload and role perception

Our plain-English summary of Inequities in reporting asbestos-related lung cancer: influence of smoking stigma and physician's specialty, workload and role perception, by P. Verger, S. Arnaud, S. Ferrer, et al (Occupational and Environmental Medicine, 2008).

The study

• Authors: P. Verger, S. Arnaud, S. Ferrer, G. Iarmarcovai, M.L. Saliba, A. Viau, M. Souville
• Journal: Occupational and Environmental Medicine
• Published: 2008;65(6):392-7
• Cited by: 26 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objectives: To study physician barriers to workers' compensation claims for asbestos-related cancers, focusing on smokers' stigma and physicians' speciality and role perception.

Methods: Cross-sectional telephone study of 486 randomly-selected general practitioners (GPs) and pulmonologists in south-eastern France. Standardised questionnaires explored their behaviour, attitudes and practices in the field of occupational health and their responses to a case vignette of a lung cancer patient with long-term occupational asbestos exposure. Randomised subgroups of GPs and pulmonologists heard alternative versions varying only as regards the worker's smoking status. We studied factors associated with the recommendation that the case vignette patient file a compensation claim with simple and multiple logistic regressions.

Results: The response rate was 64.4% among GPs and 62.5% among pulmonologists. Recommending the filing of an occupational disease claim was significantly associated in multiple logistic regressions with speciality (OR 4.46; 95% CI 2.38 to 8.37, for pulmonologists vs GPs), patient's smoking status (OR 3.15; 95% CI 2.11 to 4.70, for non-smokers vs smokers), physician's workload (OR 1.83; 95% CI 1.17 to 2.88, for </=25 consultations per day vs >25) and role perception (OR 2.00; 95% CI 1.22 to 3.27, for those who considered completing occupational disease medical certificates to be part of their role vs those who did not).

Conclusions: The results of this French study appear applicable to various countries and contexts. To make physicians and especially GPs more aware of occupational health and smoking stigma, officials and educators must give these topics higher priority during initial training and continuing medical education. Tools and equipment that take time constraints into account should be developed and disseminated to help physicians manage occupational diseases.

In plain English

The authors surveyed general practitioners (GPs) and pulmonologists in south-eastern France by telephone between November 2006 and February 2007. Of those eligible, 391 of 617 GPs and 95 of 152 pulmonologists took part. Each heard a case of a 50-year-old man with lung cancer after 20 years at a French shipyard known for high asbestos exposure. Randomly chosen subgroups were told he was either a heavy smoker or a non-smoker, and were asked whether they would advise him to file a workers' compensation claim. Among GPs, 32.7% advised a claim for the smoker and 64.1% for the non-smoker, a significant difference. Among pulmonologists the figures were 85.1% and 83.3%, not a significant difference. In a combined analysis, advising a claim was associated with being a pulmonologist rather than a GP (odds ratio 4.46, 95% CI 2.38 to 8.37), the non-smoking version (3.15, 2.11 to 4.70), having 25 or fewer consultations a day rather than more (1.83, 1.17 to 2.88), and considering occupational disease certificates part of one's role (2.00, 1.22 to 3.27). The authors noted that this design cannot show cause and effect, and that vignette answers may not reflect real practice.

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 telephone survey of physicians, including a case vignette given in two randomly assigned versions that differed only in the patient's smoking status
• Who was studied: 486 physicians in south-eastern France, surveyed November 2006 to February 2007: 391 of 617 eligible GPs (63.4%) and 95 of 152 eligible pulmonologists (62.5%), all randomly selected
• Exposure: The physicians were the subjects of the study, not asbestos-exposed workers. They heard a hypothetical case of a 50-year-old man with lung cancer after 20 years' employment at a French shipyard known for high asbestos exposure; version A described him as a heavy smoker and version B as a non-smoker. No fiber type is named. Physician factors studied included specialty, daily consultations, training and role perception.
• Main results:
  • Among GPs, a significantly higher share recommended filing a claim when the patient was a non-smoker: 64.1% of 195 GPs for the non-smoker versus 32.7% of 196 GPs for the heavy smoker (table 2, p less than 0.001)
  • Among pulmonologists, smoking status did not affect recommendations: 85.1% of 47 for the heavy smoker versus 83.3% of 48 for the non-smoker (p = 0.81)
  • In the multiple logistic regression model including specialty, pulmonologists were more likely than GPs to recommend a claim (odds ratio 4.46; 95% CI 2.38 to 8.37)
  • In the same model, the non-smoker version was associated with recommending a claim compared with the smoker version (odds ratio 3.15; 95% CI 2.11 to 4.70)
  • Physicians with 25 or fewer daily consultations were more likely to recommend a claim than those with more than 25 (odds ratio 1.83; 95% CI 1.17 to 2.88)
  • Physicians who considered completing occupational disease medical certificates part of their role were more likely to recommend a claim than those who did not (odds ratio 2.00; 95% CI 1.22 to 3.27)
  • Having had patients with asbestos-related cancers was also associated with recommending a claim in the model including specialty (odds ratio 1.93; 95% CI 1.07 to 3.47)
  • GPs who would not recommend a claim mainly considered it the role of the pulmonologist or occupational physician, not their own
• The authors' conclusion: The authors concluded that unequal reporting is linked in part to physicians' workload, knowledge and training in occupational health, their role perceptions (which differ by specialty), and the stigma attached to smokers with lung cancer
• Limitations the authors state:
  • Because the study was cross-sectional, causal inferences cannot be drawn from the associations observed
  • Responses to a case vignette may not reflect how physicians would behave in a real situation

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Lung Cancer, Asbestos Exposure, Occupational Disease.

Related studies

• Student nurses' risk perceptions of home environmental hazards — B.J. Polivka, C. Wills (2014)
• Managing malignant pleural mesothelioma: experience and perceptions of health care professionals caring for people with mesothelioma — A. Warby, H.M. Dhillon, et al. (2019)
• Palliative physicians persuade procurators fiscal — F.M. Downs, G.M. Giles, et al. (2002)
• Under-reporting of compensable mesothelioma in Alberta — M.W. Cree, M. Lalji, et al. (2009)
• Asbestosis: interstitial pulmonary fibrosis and pleural fibrosis in a cohort of asbestos insulation workers: influence of cigarette smoking — R. Lilis, I.J. Selikoff, et al. (1986)
• Influence of cigarette smoking on bronchoalveolar lavage cellularity in asbestos-induced lung disease — D.A. Schwartz, J.R. Galvin, et al. (1992)

Browse more research in Occupational and Environmental Medicine, or return to medical research.