Managing malignant pleural mesothelioma: experience and perceptions of health care professionals caring for people with mesothelioma

Our plain-English summary of Managing malignant pleural mesothelioma: experience and perceptions of health care professionals caring for people with mesothelioma, by A. Warby, H.M. Dhillon, S. Kao, et al (Supportive Care in Cancer, 2019).

The study

• Authors: A. Warby, H.M. Dhillon, S. Kao, J.L. Vardy
• Journal: Supportive Care in Cancer
• Published: 2019;27(9):3509-3519
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant pleural mesothelioma (MPM) has a poor prognosis and heavy symptom burden. Here, we investigate health professionals' attitudes to management and decision-making in people with MPM.

Methods: Survey questions were based on previous interviews with health professionals, MPM patients, and caregivers. Surveys were sent to specialist doctors and nurses who treat MPM.

Results: Surveys were completed by 107 doctors and 19 nurses from January-September 2014. Most doctors were respiratory physicians (50%) or medical oncologists (35%). Overall, 90% of doctors estimated > 10% of eligible MPM patients did not receive chemotherapy; 43% estimated the rate was > 20%. Doctors believed clinical barriers to chemotherapy were clinician nihilism (70%); non-referral to medical oncology (49%); and lack of specialists in rural/regional areas (44%). Nurses perceived barriers as follows: delayed diagnosis (74%); non-referral to medical oncology (63%); lack of clinician knowledge (58%). Patient-related barriers were negative perception of chemotherapy (83%) and belief survival benefit not worthwhile (63%). Doctors' preference in decision-making was for the patient to make the decision while strongly considering the doctor's opinion (33%); equally with the doctor (29%); and using knowledge gained (23%). Nurses described their roles as providing patient support (100%); information (95%); intermediary (74%); and link to palliative care (74%). Overall, 95% believed they enabled better resource allocation and provided patients with holistic care (95%); clearer communication (89%); more time (89%); additional information (89%); timely referrals (89%).

Conclusions: Caring for patients with MPM is challenging and complex. Health care professionals believe under-utilisation of chemotherapy is occurring, primarily due to clinician nihilism and lack of medical oncology referral.

In plain English

This was a survey of specialist doctors and nurses who care for people with malignant pleural mesothelioma (MPM) in Australia and New Zealand. Between January and September 2014, 107 doctors (mostly respiratory physicians and medical oncologists) and 19 specialist nurses completed it. It asked for their views and practices. It did not measure patients' asbestos exposure or treatment outcomes. Asked what share of patients eligible for chemotherapy did not get it, 43% of doctors and 26% of nurses estimated more than 20%. Doctors most often named "clinician nihilism regarding MPM" (70%) and non-referral to a medical oncologist (49%) as barriers. Nurses most often named delayed diagnosis (74%). Patients' negative views of chemotherapy's side effects and impact on quality of life were picked by 81% of doctors and 95% of nurses. Of all 126 respondents, 95 (75%) said they always or almost always recommend that patients seek information about compensation. The authors concluded that professionals agree chemotherapy is under-used in Australia. They noted that the survey was not fully validated, that the response rate is unknown, and that perceived barriers may differ from actual ones.

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 anonymous survey (questionnaire) of health professionals, using descriptive statistics
• Who was studied: 126 health professionals: 107 specialist doctors (53 respiratory physicians, 37 medical oncologists, and smaller numbers of other specialists) and 19 specialist nurses. They were recruited through professional organisations in Australia and New Zealand and surveyed January to September 2014.
• Exposure: Not an exposure study. The survey covered professionals' views on treatment of malignant pleural mesothelioma, especially chemotherapy, and on diagnosis, decision-making, multi-disciplinary meetings and compensation. No fiber types or exposure doses were studied.
• Main results:
  • Estimated share of chemotherapy-eligible MPM patients not receiving chemotherapy: 31% of doctors and 26% of nurses estimated 11 to 20%. 43% of doctors and 26% of nurses estimated more than 20%.
  • Main clinician-related barriers named by doctors (of 107): clinician nihilism 75 (70%), non-referral to a medical oncologist 52 (49%), and lack of services or specialists in rural or regional areas 47 (44%).
  • Main clinician-related barriers named by nurses (of 19): delayed diagnosis 14 (74%), non-referral to medical oncology 12 (63%), and lack of clinician knowledge about treatment options 11 (58%).
  • Patient negative perception of chemotherapy regarding toxicity and impact on quality of life was named as a barrier by 87 doctors (81%) and 18 nurses (95%).
  • Patient perception of insufficient survival benefit from chemotherapy was named as a barrier by 64 doctors (60%) and 15 nurses (79%).
  • Doctors' most common preference (33%) was for patients to make treatment decisions while strongly considering the doctor's opinion. No doctor (0%) preferred to make the decision alone.
  • Nurses described their main functions as support for patients (19 of 19, 100%) and information for patients (18, 95%).
  • Only 47 of 107 doctors (44%) said their practice included a lung cancer nurse specialist.
  • Of all 126 respondents, 95 (75%) said they always or almost always recommend that patients seek information about compensation.
  • Respondents saw the main barrier to general practitioners taking a detailed asbestos exposure history as lack of time (92 of 126).
• The authors' conclusion: The authors concluded that health care professionals agree chemotherapy is under-used in Australia. In their view, the main reasons reported were clinician nihilism and lack of referral to a medical oncologist.
• Limitations the authors state:
  • The survey instrument was not fully validated.
  • The response rate could not be calculated, so it is not known how representative the sample is.
  • Thoracic surgeons and radiation oncologists were under-represented.
  • The number of nurses surveyed was small.
  • Larger centres were likely over-represented, which may overestimate the MPM services available.
  • Perceived barriers to treatment may differ from actual barriers.
  • The findings reflect the Australian health setting and may not apply to other health services.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mesothelioma, Prognosis, Chemotherapy, Palliative Care.

Related studies

• Should Canadian health care professionals support the call for a worldwide ban on asbestos? — J. Siemiatycki (2001)
• A survey of patient and caregiver experience with malignant pleural mesothelioma — A. Warby, H.M. Dhillon, et al. (2019)
• Understanding the palliative care needs and experiences of people with mesothelioma and their family carers: An integrative systematic review — M. Harrison, C. Gardiner, et al. (2021)
• Experiences of healthcare professionals with support for mesothelioma patients and their relatives: Identified gaps and improvements for care — A.R. Frissen, S. Burgers, et al. (2021)
• Inequities in reporting asbestos-related lung cancer: influence of smoking stigma and physician's specialty, workload and role perception — P. Verger, S. Arnaud, et al. (2008)
• Student nurses' risk perceptions of home environmental hazards — B.J. Polivka, C. Wills (2014)

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