Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, Sydney, NSW, 2006, Australia.
Asbestos Diseases Research Institute, Bernie Banton Centre, Gate 3, Hospital Rd., Concord, NSW, 2139, Australia.
Support Care Cancer. 2019 Sep;27(9):3509-3519. doi: 10.1007/s00520-019-4648-0. Epub 2019 Jan 25.
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.
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.
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%).
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.
恶性胸膜间皮瘤（MPM）预后差，症状负担重。在这里，我们调查了卫生专业人员对 MPM 患者管理和决策的态度。
调查问题基于之前对卫生专业人员、MPM 患者和护理人员的访谈。调查分发给治疗 MPM 的专科医生和护士。
2014 年 1 月至 9 月，107 名医生和 19 名护士完成了调查。大多数医生是呼吸内科医生（50%）或肿瘤内科医生（35%）。总的来说，90%的医生估计有>10%的符合条件的 MPM 患者未接受化疗；43%的医生估计这一比例>20%。医生认为化疗的临床障碍是医生的虚无主义（70%）；未转诊至肿瘤内科（49%）；以及农村/地区缺乏专家（44%）。护士认为的障碍如下：诊断延迟（74%）；未转诊至肿瘤内科（63%）；缺乏临床医生知识（58%）。患者相关的障碍是对化疗的负面看法（83%）和认为生存获益不值得（63%）。医生在决策中的偏好是让患者做出决定，同时强烈考虑医生的意见（33%）；与医生平等（29%）；并利用所获得的知识（23%）。护士描述了他们的角色，包括为患者提供支持（100%）；提供信息（95%）；作为中间人（74%）；以及与姑息治疗联系（74%）。总的来说，95%的人认为他们能够更好地分配资源，并为患者提供全面的护理（95%）；更清晰的沟通（89%）；更多的时间（89%）；更多的信息（89%）；及时转诊（89%）。
照顾 MPM 患者具有挑战性且复杂。医疗保健专业人员认为，化疗的利用率不足，主要是由于医生的虚无主义和缺乏肿瘤内科的转诊。
