Abstract：
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.
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.
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.
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.
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.
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.
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.
摘要：
恶性胸膜间皮瘤是一种罕见的，以前接触石棉引起的无法治愈的癌症；患者预后不良，中位生存率为8-14个月。由于缺乏多学科知识共享，间皮瘤临床决策的差异仍然很普遍。导致治疗决策不一致。该研究旨在探讨哪些因素影响临床医生在间皮瘤治疗中的决策，以优化间皮瘤护理途径。
这项混合方法研究包括对地方和国家指南的文献分析，有关间皮瘤护理途径的政策或文件，间皮瘤患者数据的二次分析，以及参加肺癌和/或间皮瘤特异性多学科小组会议的临床医生的访谈。这项研究是在英格兰的三个国家卫生服务信托基金中进行的。对与患者治疗途径相关的文件进行了整理和定性审查。间皮瘤患者的记录从医院的患者记录和诊断日期收集的数据中提取，治疗,死亡率,生存诊断后，年龄和临床护理团队。对数据进行统计分析。与临床医生的访谈探讨了对临床决策的影响，包括所涉及的挑战或障碍。对数据进行了主题分析。使用《加强流行病学报告中的观察研究报告清单》。
信托之间的间皮瘤治疗和护理的结构和递送存在差异。确定了四个主要主题：“合作与交流”，“证据基础和知识”，“临床医生的角色”和“患者的角色”。确定了两个交叉主题，涉及间皮瘤护士专家的作用和COVID-19的影响。
有必要审查间皮瘤多学科小组会议的结构，以确保具有适当知识的临床医生对患者进行审查。专业知识和对如何的理解，为什么以及何时应该做出决定。间皮瘤护理专家临床医生需要在更广泛的多学科团队中推广最新的证据和知识库。
这项混合方法研究包括对地方和国家指南的文献分析，有关间皮瘤护理途径的政策或文件，间皮瘤患者数据的二次分析，以及参加肺癌和/或间皮瘤特异性多学科小组会议的临床医生的访谈。这项研究是在英格兰的三个国家卫生服务信托基金中进行的。对与患者治疗途径相关的文件进行了整理和定性审查。间皮瘤患者的记录从医院的患者记录和诊断日期收集的数据中提取，治疗,死亡率,生存诊断后，年龄和临床护理团队。对数据进行统计分析。与临床医生的访谈探讨了对临床决策的影响，包括所涉及的挑战或障碍。对数据进行了主题分析。使用《加强流行病学报告中的观察研究报告清单》。
信托之间的间皮瘤治疗和护理的结构和递送存在差异。确定了四个主要主题：“合作与交流”，“证据基础和知识”，“临床医生的角色”和“患者的角色”。确定了两个交叉主题，涉及间皮瘤护士专家的作用和COVID-19的影响。
有必要审查间皮瘤多学科小组会议的结构，以确保具有适当知识的临床医生对患者进行审查。专业知识和对如何的理解，为什么以及何时应该做出决定。间皮瘤护理专家临床医生需要在更广泛的多学科团队中推广最新的证据和知识库。
