Development of a history-taking form for mesothelioma patients at risk of exposure to asbestos

Our plain-English summary of Development of a history-taking form for mesothelioma patients at risk of exposure to asbestos, by R. Singh, R. Kumar, M. Nagar, et al (Public Health Action, 2025).

The study

• Authors: R. Singh, R. Kumar, M. Nagar, S.B. Kaipilyawar, H.A. Anderson, A.V. Jadhav, T. Patel, T.R. Drischoll, E. Prriya, S.R. Yadav, S. Bishnoi, N. Singh, K. Kaur, A. Jakhetiya, N. van Zandwijk, S. Kumari, D. Khosla, S. Rajan, A.K. Verma, A. Bhatt, A. Sharma, D.K. Sinha, A. Kapoor, R. Gill, R. Dada, J. Kishore, A.L. Frank
• Journal: Public Health Action
• Published: 2025;15(4):160-163
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Mesothelioma is causally established to be primarily related to asbestos exposure as a risk factor. Before considering other possible causative factors for mesothelioma, a detailed exposure history is warranted, which looks at possible prior exposures to asbestos. Some exposures may be unknown to patients, may be forgotten or may not be readily available as a comprehensive tool for the clinicians dealing with mesothelioma patients.

Methods: We used the Delphi anonymous consensus technique to develop and validate a detailed, seven-sectioned, and comprehensive questionnaire that can be readily used by clinicians and researchers. Over two rounds, the experts followed a thorough and rigorous process to validate the questionnaire, including medical history along with occupational, non-occupational as well as para-occupational exposure to asbestos, and many other parameters that can be both rule in and rule out the possibility of mesothelioma. Questions have also been included to factor in other types of dust exposure for an informed differential diagnosis.

Results: We have created a readily available history-taking questionnaire validated by experts, which can be replicated for other conditions and become an essential tool for diagnosis.

Conclusion: Apart from accurate and informed diagnosis, this documentation can be valuable for epidemiological, research, policy-informing, legal and compensation related issues.

© 2025 The Authors.

In plain English

This article described how the authors built a history-taking questionnaire for doctors seeing patients with mesothelioma or suspected mesothelioma. It was not a study of patients. The authors drafted questions from published literature on occupational, para-occupational (household) and non-occupational asbestos exposure. They then refined the questions through a Delphi process: two rounds of anonymous feedback from 30 experts, 20 of whom treated mesothelioma patients and 10 of whom worked in diagnosis or related research. The final form had seven sections, covering background, medical history, occupation, environmental, non-occupational and household exposures, and other dusts. In round 1 no expert rejected any section. Full acceptance ranged from 16 experts for the medical-history section to 25 for the environmental-exposure section. The authors stated that the tool would help primary and secondary care doctors take exposure histories. They noted it has not been field-tested for reliability and validity, and that the expert panel could have been more globally diverse. Two authors disclosed medical-legal work mainly for plaintiffs or workers.

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: Development of a questionnaire using a two-round Delphi expert consensus process (not a study of patients)
• Who was studied: 30 experts: 20 who dealt with mesothelioma patients clinically (medical, surgical and radiation oncologists, pulmonologists, internal medicine and occupational physicians) and 10 who dealt with diagnosis and exposure history or did allied research (e.g., pathologists, community medicine, nursing, genetics, toxicology, epidemiology, public health). The experts' countries and the dates of the rounds are not stated.
• Exposure: No exposure was measured. The questionnaire asks about occupational, non-occupational, para-occupational and environmental asbestos exposure, plus other dust exposures for differential diagnosis. No specific fiber types are named.
• Main results:
  • The final questionnaire had 7 sections: one on patient background, occupation and region of work and residence, and Sections A to F covering medical history, occupation, environmental exposures, non-occupational exposures, para-occupational exposures, and other exposures.
  • Medical-history section (Section A), round 1: 16 of the 30 experts accepted it as it was and 14 suggested revisions, such as more detailed smoking, cough and family cancer history. This was the lowest full acceptance of any section.
  • Environmental-exposure section (Section C), round 1: 25 experts accepted it as it was and 5 suggested revisions. Additional exposures, including an asbestos textile unit, were added.
  • Para-occupational section (Section E), round 1: 24 experts (80%) accepted it as it was and 6 (20%) suggested revisions. None rejected it. A question on cleaning or washing a family member's clothes was added.
  • Occupation-history section (Section B), round 1: 20 experts accepted it as it was and 10 suggested revisions, adding more possible occupations from around the world. Non-occupational section (Section D): 23 accepted and 7 suggested revisions. Other-exposures section (Section F): 22 accepted and 8 suggested revisions.
  • Occupation-status section: in round 1, 22 experts accepted it and 8 suggested revisions. In round 2, 8 experts suggested further changes to the revised version.
  • Experts commented on misdiagnosis, noting that many mesothelioma patients are taking, or have taken, anti-TB drugs by the time they reach the clinic where their mesothelioma is diagnosed.
• The authors' conclusion: The authors concluded that they had developed a questionnaire covering occupational, non-occupational and para-occupational asbestos exposure that would be a useful tool at primary and secondary care levels. They called for pilot implementation in clinical settings, use in epidemiological and legal settings, and translation into local languages.
• Limitations the authors state:
  • The expert panel could have been more globally diverse.
  • The selection of experts may have been biased.
  • A Delphi consensus may need more than two rounds in some contexts.
  • The tool has not been field-tested for reliability and validity beyond expert consensus on its content, and further data may be needed to validate it clinically.
  • The list of exposure sources may need to be filled out by a systematic literature review and may vary by region.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Asbestos Exposure, Exposure History, Take-home Exposure, Differential Diagnosis.

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