Open access phone triage for veterans with suspected malignant pleural mesothelioma

Our plain-English summary of Open access phone triage for veterans with suspected malignant pleural mesothelioma, by C.J. Siegert, P.M. Fisichella, J.M. Moseley, et al (The Journal of Surgical Research, 2017).

The study

• Authors: C.J. Siegert, P.M. Fisichella, J.M. Moseley, M. Shoni, A. Lebenthal
• Journal: The Journal of Surgical Research
• Published: 2017;207:108-114
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Phone triaging patients with suspected malignant pleural mesothelioma (MPM) within the Veterans Healthcare Administration (VHA) system offers a model for rapid, expert guided evaluation for patients with rare and treatable diseases within a national integrated healthcare system. To assess feasibility of national open access telephone triage using evidence-based treatment recommendations for patients with MPM, measure timelines of the triage and referral process and record the impact on "intent to treat" for patients using our service.

Methods: A retrospective study. The main outcome measures were: (1) ability to perform long distance phone triage, (2) to assess the speed of access to a mesothelioma surgical specialist for patients throughout the entire VHA, and (3) to determine if access to a specialist would alter the plan of care.

Results: Sixty veterans were screened by our phone triage program, 38 traveled an average of 997 miles to VA Boston Healthcare system. On average, 14 d elapsed from initial phone contact until the patient was physically evaluated in our general thoracic clinic in Boston. The treatment plan was altered for 71% of patients evaluated at VA Boston Healthcare system based on 2012 International Mesothelioma Interest Group guidelines.

Conclusions: Our initial experience demonstrates that in-network centralized care for Veterans with MPM is feasible within the VHA. National open access phone triage improves access to expert surgical advice and can be delivered in a timely manner for Veterans using our service. Guideline-based treatment recommendations ("intent to treat") changed the therapeutic course for the majority of patients who used our service.

Copyright © 2016 Elsevier Inc. All rights reserved.

In plain English

This retrospective study reviewed the records of everyone who used an open access phone triage service for suspected malignant pleural mesothelioma at the VA Boston Healthcare System between January 2011 and January 2015. A thoracic surgeon focused on the disease screened callers by phone. Of 74 callers, 14 were not US veterans and were excluded, leaving 60 veterans, all male, with an average age of 68. Of these, 38 (63.3%) traveled to Boston, an average of 997 miles, and were seen on average 14 days after first phone contact. Only 10.5% of the veterans who came to Boston had been offered surgery locally. The Boston team recommended surgery for 76.3% of them (76.5% in another passage). For 27 of the 38 (71%), the care plan was changed based on 2012 International Mesothelioma Interest Group guidelines. The mesothelioma diagnosis was changed for four patients: three had benign pleural disease and one had lung cancer. The authors concluded that open access phone triage was possible and enabled timely specialized care. They noted that the cohort was small and likely a select group. The article did not report asbestos-exposure measurements.

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: retrospective study (review of data on all patients who used a phone triage service)
• Who was studied: 74 people contacted the phone triage at VA Boston Healthcare System between January 2011 and January 2015. 14 who were not US veterans were excluded, leaving 60 veterans, all male, with an average age of 68. 38 of them traveled to Boston for consultation.
• Exposure: Not an asbestos exposure study, and the article reports no asbestos-exposure measurements for these veterans. What was studied was an open access telephone triage service run by a general thoracic surgeon specializing in malignant pleural mesothelioma, followed by in-person evaluation in Boston.
• Main results:
  • Veterans who traveled to Boston were seen on average 14 days after initial phone contact (variation given as 10.3).
  • 38 of the 60 veterans (63.3%) traveled to VA Boston. 34% were from New England and the rest came from 20 additional states. The average distance traveled was 997 miles.
  • Of the 38 veterans who traveled for consultation, 27 (71%) had their initial care plan altered based on the 2012 International Mesothelioma Interest Group guidelines.
  • Among the veterans who came to Boston, only 10.5% had been offered surgery locally, and all of these lived in New England. 89.5% had been considered nonsurgical candidates by local multidisciplinary teams.
  • The Boston team recommended surgical resection for 76.5% of those who completed consultation (given as 76.3% in the Results section).
  • The diagnosis of malignant pleural mesothelioma was changed for four patients who traveled to Boston: three had benign pleural disease and one had poorly differentiated non-small-cell lung cancer.
  • 53% of the veterans and/or their families found the service through internet resources. 24% were referred by a medical provider, 5% came through the service's website, and 18% had no known referral data.
• The authors' conclusion: The authors concluded that open access phone triage for veterans with malignant pleural mesothelioma is possible and enabled timely specialized evidence-based care nationally. They also concluded that expert evaluation changed the treatment recommendations for most veterans who were encouraged to travel for consultation.
• Limitations the authors state:
  • The true number and incidence of malignant pleural mesothelioma in veterans is unknown.
  • The cohort is small.
  • The veterans seeking the authors' advice are likely a select group within the VHA who proactively sought surgical care.
  • Hard data on the time spent on screening could not be calculated retrospectively.

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, Mesothelioma.

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