Missed opportunities to counsel patients with malignant pleural mesothelioma about causation and potential compensation

Our plain-English summary of Missed opportunities to counsel patients with malignant pleural mesothelioma about causation and potential compensation, by W.G. Kuschner, R. Varma, R. Flores, et al (The American Journal of the Medical Sciences, 2012).

The study

• Authors: W.G. Kuschner, R. Varma, R. Flores, M. Agrawal, S. Guvenc-Tuncturk
• Journal: The American Journal of the Medical Sciences
• Published: 2012;343(3):206-9
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Malignant pleural mesothelioma (MPM) is a lethal malignancy strongly associated with occupational exposure to asbestos. The aims of this study were to assess the quality of counseling provided to patients with MPM about the causation of MPM and the potential for compensation.

Methods: The authors conducted a structured retrospective chart review of patients with a diagnosis of MPM. They abstracted demographic data, occupational and environmental history and exposure data. They also searched for documentation of patient education and counseling.

Results: The authors identified 16 patients with a new diagnosis of MPM during the study period. A job title was documented at least once in the records of 12 (75%) patients. Documentation of occupational exposure to asbestos was found in the records of 12 (75%) patients. Two patients (13%) were presumed to have had bystander exposure to asbestos. Education about MPM causation and counseling about opportunities for compensation were documented in the record of 1 patient (6%).

Conclusions: Among patients with MPM, documentation of some elements of an occupational history, including an occupational asbestos exposure history, was common. Advice to pursue compensation for potential occupation related MPM was rare. Physicians may be missing opportunities to provide beneficial information to patients with newly diagnosed MPM regarding potential legal redress and compensation.

In plain English

This retrospective review examined medical records at the U.S. Department of Veterans Affairs Palo Alto Health Care System in California. Of 26 patients newly coded with a pleural cancer between 1999 and 2009, 16 had pathologically confirmed malignant pleural mesothelioma. Their median age was 72 years and 15 (94%) were men. A job title was recorded for 12 patients (75%) and specific job duties for 2 (13%). The text reports documented occupational asbestos exposure in 12 patients (75%), while the article's table lists 11 (69%). Two patients were presumed to have had bystander exposure through family members who worked with asbestos, and 3 (19%) had no asbestos exposure recorded. Only 1 patient, exposed during U.S. Navy service, had documented education about the link between asbestos and mesothelioma and a referral to a compensation and pension panel. No patient's record documented advice to seek legal counsel. The authors concluded that physicians may be missing opportunities to inform patients about causation and compensation. They noted that education given but not written in the records could not be detected.

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: Structured retrospective review of medical records (chart review)
• Who was studied: 16 patients with pathologically confirmed malignant pleural mesothelioma, out of 26 with a newly entered diagnosis code for pleural malignancy, January 1, 1999, through December 31, 2009, at the U.S. Department of Veterans Affairs Palo Alto Health Care System (California), which serves military veterans. Median age at diagnosis was 72 years (range 51 to 90), and 15 (94%) were men. Records were reviewed from 1 year before to 1 year after the diagnosis code was entered, or until death.
• Exposure: Asbestos exposure as documented in the records: occupational exposure (known or presumed), and bystander exposure from family members who worked with asbestos and were believed to have carried fibers home. No fiber type is named. The one counseled patient was exposed during U.S. Navy service.
• Main results:
  • A job title was documented at least once for 12 of 16 patients (75%).
  • Specific job duties were documented for 2 of 16 patients (13%).
  • The text reports occupational asbestos exposure, known or presumed, documented for 12 patients (75%). Table 1 lists 11 (69%) with occupational exposure, 2 (13%) with bystander exposure and 3 (19%) with no documented asbestos exposure.
  • Bystander asbestos exposure was presumed for 2 of 16 patients (13% in Table 1).
  • No asbestos exposure was documented for 3 of 16 patients (19%).
  • Education and counseling were documented for 1 of 16 patients (6%). This patient had asbestos exposure during U.S. Navy service, was educated about the asbestos and mesothelioma association, and was advised to pursue evaluation through a compensation and pension panel.
  • Advice to seek legal counsel was not documented for any patient (0 of 16). Referral to a claims board was documented in 1 case.
• The authors' conclusion: The authors concluded that documenting some parts of an occupational history was common, but that physicians may be missing opportunities to give patients with newly diagnosed malignant pleural mesothelioma information about the cause of the disease and possible legal redress and compensation.
• Limitations the authors state:
  • The authors stated that their main limitation is that they could not know whether patients received education about causation and compensation that was not documented in the medical record.
  • Some patients may have received care outside the facility, or learned about legal redress from other sources.
  • Details about the total population of patients with malignant pleural mesothelioma who are entitled to compensation remain unknown.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Causation, Occupational Exposure, Bystander Exposure, Occupational History, Asbestos Exposure.

Related studies

• Compensation of pleural mesothelioma in France: data from the French National Mesothelioma Surveillance Programme — S. Chamming's, B. Clin, et al. (2013)
• Compensation for environmental asbestos-related diseases in South Africa: a neglected issue — N. Ndlovu, J.T. Naude, et al. (2013)
• Choice of rating method for assessing occupational asbestos exposure: study for compensation purposes in France — C. Gramond, P. Rolland, et al. (2012)
• Yokohama declaration for fair and equal compensation for all asbestos victims and their families — B. Terracini (2008)
• Criminal investigation follows report on asbestos compensation fund — B. Burton (2004)
• Research needed for mesothelioma. Financial compensation after death is no panacea — E. Lanzetta (2003)

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