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Lung cancer
Understanding clinical decision-making in mesothelioma care: a mixed methods study
  1. Catherine Henshall1,2,
  2. Paul Dawson1,
  3. Najib Rahman3,4,5,
  4. Hannah Ball6,
  5. Anand Sundralingam3,4,
  6. Mitra Shahidi7,
  7. Edward McKeown8,
  8. John Park3,4,
  9. Helen Walthall9 and
  10. Zoe Davey1
  1. 1Oxford School for Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
  2. 2Oxford Health NHS Foundation Trust, Warneford Hospital, Warneford Lane, Oxford, UK
  3. 3Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Oxford University, Oxford, UK
  4. 4Oxford Respiratory Trials Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
  5. 5Oxford Biomedical Research Centre, Oxford, UK
  6. 6Cancer Nursing, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  7. 7Respiratory Medicine, Buckinghamshire Healthcare NHS Trust, Amersham, UK
  8. 8Respiratory Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK
  9. 9Nursing and Midwifery Research and Innovation, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  1. Correspondence to Dr Catherine Henshall; chenshall{at}brookes.ac.uk

Abstract

Introduction Malignant pleural mesothelioma is a rare, incurable cancer arising from previous asbestos exposure; patients have a poor prognosis, with a median survival rate of 8–14 months. Variation in mesothelioma clinical decision-making remains common with a lack of multidisciplinary knowledge sharing, leading to inconsistencies in treatment decisions. The study aimed to explore which factors impacted on clinicians’ decision-making in mesothelioma care, with a view to optimising the mesothelioma care pathway.

Methods This mixed methods study consisted of documentary analysis of local and national guidelines, policies or documents pertaining to mesothelioma care pathways, secondary analysis of mesothelioma patient data, and interviews with clinicians attending lung cancer and/or mesothelioma-specific multidisciplinary team meetings. The study took place at three National Health Service trusts in England. Documentations relating to patients’ treatment pathways were collated and reviewed qualitatively. Records of patients with mesothelioma were extracted from hospital patient records and data collected on diagnosis date, treatment, mortality rates, survival postdiagnosis, age and clinical care team. Data were statistically analysed. Interviews with clinicians explored influences on clinical decision-making, including challenges or barriers involved. Data were thematically analysed. The Strengthening the Reporting of Observational Studies in Epidemiology reporting checklist was used.

Results There were differences in the structure and delivery of mesothelioma treatment and care between trusts. Four main themes were identified: ‘collaboration and communication’, ‘evidence base and knowledge’, ‘role of the clinician’ and ‘role of the patient’. Two cross-cutting themes relating to the role of the mesothelioma nurse specialist and the impact of COVID-19 were identified.

Discussion There is a need to review the structure of mesothelioma multidisciplinary team meetings to ensure patients are reviewed by clinicians with appropriate knowledge, expertise and understanding of how, why and when decisions should be made. There is a need for expert clinicians in mesothelioma care to promote an up-to-date evidence and knowledge base within the wider multidisciplinary team.

  • Mesothelioma
  • Asbestos Induced Lung Disease
  • Palliative Care
  • Pleural Disease
  • Rare lung diseases

Data availability statement

Data are available upon reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjresp-2022-001312

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors CH takes responsibility for the content of the manuscript, including the data and analysis. CH designed the study and ZD and PD undertook the data collection and analysis, with contributions and input from CH, AS, NR, HB, MS and EM. All authors were responsible for interpreting the data. CH and ZD drafted the manuscript and its intellectual content was reviewed and critiqued by all authors. CH is acting as the guarantor.

    • Funding The study was funded by Mesothelioma UK.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.