Improving mesothelioma follow-up care in the UK: a qualitative study to build a multidisciplinary pyramid of care approach

Our plain-English summary of Improving mesothelioma follow-up care in the UK: a qualitative study to build a multidisciplinary pyramid of care approach, by Z. Davey, C. Henshall (BMJ Open, 2021).

The study

• Authors: Z. Davey, C. Henshall
• Journal: BMJ Open
• Published: 2021;11(11):e048394
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: The findings reported in this manuscript are part of a wider study that aimed to explore mesothelioma patients' experiences of follow-up care. The aim of this phase of the study was to co-produce recommendations for policy and practice and to propose a revised, patient-focused, mesothelioma follow-up care service.

Design: The consultation phase was qualitative and consisted of three group discussions with separate stakeholder groups allowing for different priorities and needs for follow-up care to be compared. An implicit approach to consensus was adopted and data were analysed iteratively using the framework method.

Setting: The study was conducted in three National Health Service Trusts in the South of England. Two were secondary care settings and the third was a tertiary centre.

Participants: The consultation exercise comprised three group discussions with key stakeholders (n=35): mesothelioma specialist nurses (n=9), mesothelioma patients and carers (n=11) and local clinical commissioning group members (n=15).

Results: Recommendations for mesothelioma follow-up care were developed using a co-production approach and highlighted the importance of continuity of care, the provision of timely information and the central role played by mesothelioma specialist nurses, supported by the wider multidisciplinary team. Recommendations were produced together with two bespoke infographics to maximise impact and facilitate patient and public engagement with the study.

Conclusions: The recommendations developed are the first that specifically examine best practice for the follow-up care pathway for mesothelioma patients. Co-production and public engagement are crucial to priority setting develop and optimising patient-centred care. Combining the recommendations produced with a targeted dissemination strategy and well-designed, patient-focused infographics will maximise opportunities for impact at a regional and national level.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

In plain English

This qualitative study reported the final consultation phase of a wider study of mesothelioma patients' experiences of follow-up care in three NHS Trusts in the South of England. The authors held three group discussions with 35 stakeholders: mesothelioma specialist nurses (9), patients with malignant pleural mesothelioma and carers (11), and local clinical commissioning group members (15). Participants discussed a summary of earlier interview findings. The authors analysed the discussions using the framework method. The study did not examine asbestos exposure. Six overarching recommendations were developed. Continuity of care was a common thread in the discussions. The core recommendation was that all patients have access to a mesothelioma specialist nurse within a respiratory led care pathway. Communicating information was given priority over providing information resources. The authors proposed a 'pyramid of care' with a named mesothelioma specialist nurse at the top, supported by a named respiratory consultant and the wider team, and they produced two infographics. The authors concluded that these were, to their knowledge, the first recommendations specifically on mesothelioma follow-up care. The authors noted that the processes they used were not formally evaluated.

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: Qualitative study: the consultation phase (three stakeholder group discussions) of a wider qualitative study, analysed with the framework method
• Who was studied: 35 stakeholders in three group discussions: 9 mesothelioma specialist nurses, 11 patients with malignant pleural mesothelioma (MPM) and carers, and 15 local clinical commissioning group members. The wider study was based in three NHS Trusts in the South of England, and the consultation phase also included stakeholders from other regions of the UK.
• Main results:
  • The findings were developed into six overarching recommendations for mesothelioma follow-up care, each with detailed subsidiary recommendations.
  • Continuity of care was a common thread across the stakeholder discussions.
  • The core recommendation was that all patients with MPM have access to a mesothelioma specialist nurse within a respiratory led care pathway.
  • Communicating information was given priority over providing information resources.
  • A 'pyramid of care' was proposed, with a named mesothelioma specialist nurse at the top, supported by a named respiratory consultant and the wider multidisciplinary team.
  • Two infographics were produced, one for the pyramid of care and one for the key recommendations.
• The authors' conclusion: The authors concluded that improving and streamlining the follow-up pathway, by focusing on continuity and joined up care and elevating specialist mesothelioma roles within a respiratory led service, has the potential to improve the consistency and quality of care for patients with MPM across the UK. They described these as, to their knowledge, the first recommendations specifically on best practice for mesothelioma follow-up care.
• Limitations the authors state:
  • The co-production, priority setting and consensus development processes were not formally evaluated.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Mesothelioma Specialist, Multidisciplinary Team.

Related studies

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• Understanding the Experiences of end of Life Care for Patients with Mesothelioma from the Perspective of Bereaved Family Caregivers in the UK: A Qualitative Analysis — M. Harrison, L. Darlison, et al. (2022)
• Clinical nurse specialist role in providing generalist and specialist palliative care: A qualitative study of mesothelioma clinical nurse specialists — C. Gardiner, M. Harrison, et al. (2022)
• Living with mesothelioma: A qualitative study of the experiences of male military veterans in the UK — S. Ejegi-Memeh, L. Darlison, et al. (2021)
• Understanding clinical decision-making in mesothelioma care: a mixed methods study — C. Henshall, P. Dawson, et al. (2022)
• Improving outcomes in malignant pleural mesothelioma in an integrated health care system — S. Ossowski, Y.Y. Hung, et al. (2022)

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