Validation of an Asbestos Exposure Questionnaire (QEAS-7) for Clinical Practice

Our plain-English summary of Validation of an Asbestos Exposure Questionnaire (QEAS-7) for Clinical Practice, by J. Ferrer, G. Granados, S. Hernández, et al (International Journal of Environmental Research and Public Health, 2020).

The study

• Authors: J. Ferrer, G. Granados, S. Hernández, M.J. Cruz, J. Sampol, D. Álvarez Simón, J.M. Ramada
• Journal: International Journal of Environmental Research and Public Health
• Published: 2020;17(24)
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: The seven-item QEAS-7 questionnaire (exposure to asbestos questionnaire) has been designed as a useful and simple tool to establish the probability of exposure to asbestos. The objective of the present study is to validate the QEAS-7 following the recommended methodology.

Methods: The QEAS-7 was prospectively administered to 90 subjects with and without asbestos-related disease (ARD), on two consecutive occasions by two independent researchers. Logical and content validity was evaluated by a committee of experts and construct validity through hypothesis testing. Intra- and interobserver reliability was assessed by calculating Cohen's Kappa index (κ), which was estimated as weak if below 0.40, moderate if between 0.41 and 0.60 and good/very good if above 0.60. The comparison between proportions was examined using Pearson's Chi-square test.

Results: The majority of participants (88.9%) were male. Mean age was 70.8 years (SD = 8.4) and most of the sample had completed primary education but had not progressed further (62.2%). Forty-three had ARD. The logical, content and construct validity of the QEAS-7 was considered adequate both by a committee of experts and by the users interviewed. The mean administration time was 9 min and 25 s (SD = 3 min and 49 s). The verification of the five hypotheses confirmed the construct validity and the intra- and interobserver reliability to be κ = 0.93 and κ = 0.50 respectively. The concordance in the estimation of asbestos exposure was κ = 0.65.

Conclusions: The QEAS-7 is a simple, valid and reliable tool for estimating the probability of exposure to asbestos. Its application in clinical practice appears justified. What is already known about this subject? No studies have been published to date on the validation of specific questionnaires designed to determine asbestos exposure for routine use by healthcare staff in the clinical setting. What are the new findings? This questionnaire can be considered a comprehensible, viable, valid and reliable instrument for identifying exposure to asbestos. Its brevity and simplicity of administration make it ideally suited for use in daily clinical practice. How might this impact on policy or clinical practice in the foreseeable future? This questionnaire can be of help for physicians attending to patients with suspected asbestos-related diseases both in the hospital and in the primary care setting.

In plain English

The authors ran a prospective, observational study to test whether a seven-question asbestos exposure questionnaire, the QEAS-7, works in everyday clinical care. In 2013 and 2014 they gave it to 90 patients from an outpatient respiratory clinic at a public hospital in Barcelona. Forty-three had a known asbestos-related disease, mostly pleural plaques, and 47 did not. Experts and patients found it understandable. It took on average 9 minutes 25 seconds. In the article's table of hypothesis tests, the questionnaire classed 95.35% of patients with asbestos-related disease and 61.70% of those without as having definite or probable occupational exposure (p less than 0.001). Another table in the article gives different figures. Agreement between two sittings with the same interviewer was kappa 0.93. Between two interviewers it was kappa 0.50. A hygienist and a pulmonologist rating the answers agreed at kappa 0.65. The authors concluded the QEAS-7 is a simple, valid and reliable tool. They noted that most participants did manual work, which may have overestimated exposure, and that the questionnaire was tested only in a Spanish convenience sample.

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: Prospective, observational questionnaire validation study
• Who was studied: 90 patients (80 men) from the outpatient respiratory clinic of a tertiary public hospital in Barcelona, recruited as a convenience sample in 2013 and 2014: 43 with and 47 without a known asbestos-related disease; mean age 70.8 years
• Exposure: Asbestos exposure as recorded by the QEAS-7: three questions on occupational exposure, two on domestic and two on environmental exposure, plus lists of 48 occupations/activities and 70 materials. Only occupational exposure, rated definite, probable, nonexistent or unknown, was used in the validation. No fiber types are specified.
• Main results:
  • Of the 43 participants with asbestos-related disease, most had pleural plaques (22, 51.2%). Other diagnoses included asbestosis (6), lung cancer (2) and mesothelioma (1).
  • Mean time to administer the questionnaire was 9 minutes 25 seconds (SD 3 minutes 49 seconds). No item caused comprehension difficulty for more than 15% of interviewees.
  • Hypothesis tests (Table 3): definite or probable occupational exposure was found in 95.35% of participants with asbestos-related disease versus 61.70% without (p less than 0.001).
  • Among participants with asbestos-related disease, 41 (95%) had definite or probable occupational exposure according to the questionnaire.
  • Definite or probable occupational exposure was found in 85% of participants with manual jobs versus 62.07% with nonmanual jobs (p 0.015).
  • Among participants without a history of exposure in their medical history, 27 (60%) were classed as exposed; no denominator is given.
  • Definite or probable occupational exposure was found in 95.83% of participants with pleural plaques and/or asbestos bodies versus 63.27% without (p 0.003).
  • Table 1 classification. Without asbestos-related disease (n = 47): definite 18 (38.3%), probable 5 (10.6%), nonexistent 24 (51.1%). With asbestos-related disease (n = 43): definite 28 (65.1%), probable 9 (20.9%), nonexistent 6 (14.0%). p = 0.001.
  • Test-retest (same interviewer, 2 to 3 weeks apart) reliability was kappa 0.93. Interobserver reliability (two interviewers, in a subgroup) was kappa 0.50, described by the authors as moderate.
  • Agreement between the hygienist (expert) and the pulmonologist (nonexpert) in rating exposure was kappa 0.65.
  • Using the hygienist's rating as reference, the pulmonologist's ratings had a false positive rate of 1.1% and a false negative rate of 2.2%. They were higher than the hygienist's in 13.2% of cases and lower in 6.6%.
• The authors' conclusion: The authors concluded that the QEAS-7 is a simple, comprehensible, valid and reliable tool that can help physicians attending patients with suspected asbestos-related disease, in hospital and in primary care.
• Limitations the authors state:
  • Most participants had manual jobs likely to involve asbestos contact, raising the possibility of selection and memory bias that may have overestimated exposure.
  • Because a convenience sample of outpatients was used, the authors could not assess the questionnaire for employees of firms with very specific asbestos exposure risks.
  • The validation was done in the Spanish population only. The authors state that cultural adaptation and validation would be needed before use in other countries.
  • Internal consistency (Cronbach's alpha) could not be calculated because of the questionnaire's structure.
  • Domestic and environmental exposures were not taken into account in the validation.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Foreseeability.

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