ABSTRACT
BACKGROUND: Occupational exposures in mining and oil/gas extraction are known risk factors for thoracic malignancies (TMs). Given the relatively high proportion of these industries in New Mexico (NM), we conducted a feasibility study of adult lifetime occupational history among TM cases. We hypothesized a higher proportion of occupational TM in NM relative to the estimated national average of 10-14%. METHODS: We identified incident TM cases through the population-based New Mexico Tumor Registry (NMTR), from 2017-2018. Cases completed a telephone interview. An adjudication panel reviewed case histories and classified cancers as probable, possible, or non-occupational related, taking into account the presence, duration, and latency of exposures. We characterized recruitment and describe job titles and exposures among those with occupational TMs. We also compared the distributions of industry between those with and without occupational TM. RESULTS: The NMTR identified 400 eligible TM cases, 290 of which were available to be recruited (n=285 lung/bronchial cancer; n=5 mesotheliomas). Of the latter, 60% refused and 18% were deceased, 9% had invalid addresses, 11% were unable to be reached by telephone, and 3% were too ill to participate. The 43 cases who completed an interview held 236 jobs. A total of 33% of cases were classified as probable occupational TM and 5% as possible occupational TM. CONCLUSIONS: High rates of early mortality and refusals were significant barriers to study participation. Nonetheless, the proportion of probable occupational TMs greatly exceeded the estimated national average, highlighting the need for further study of occupational TM in the state.
ABSTRACT
INTRODUCTION: The re-emergence of pneumoconiosis, particularly among coal miners (ie black lung), in the USA is a challenge for rural communities because more miners require specialized care while expertise is scarce. The Miners' Wellness TeleECHO (Extension for Community Health Outcomes) Clinic, jointly held by the University of New Mexico and a community hospital in New Mexico, provides structured telementoring to professionals caring for miners, including clinicians, respiratory therapists, home health professionals, benefits counselors, lawyers/attorneys and others, forming a virtual 'community of practice'. This approach has not been utilized and evaluated previously. METHODS: The study's bimonthly program uses the ECHO telementoring model, which uses technology to leverage scarce mentoring resources; uses a disease-management model that is proven to improve outcomes in other disease states, by reducing variation in processes of care and sharing best practices; uses the principle of case-based learning with highly contextualized discussions, which fulfils key learning theory principles; creates a virtual community of practice; and uses an internet-based database to monitor outcomes. This 1-year cross-sectional study from September 2018 to September 2019 used geographical mapping of all attendee locations, web-based continuing medical education surveys completed by attendees using iECHO software, and a Research Electronic Data Capture-based survey of a convenience sample of participants, which obtained detailed information on demographics, knowledge, self-efficacy and collective efficacy. Knowledge sharing among participants was examined using insights and methods from social network analysis. Subgroup analysis involved comparisons between clinical and non-clinical professional groups, and between new and existing participants. Groups were compared using Fisher's exact test for categorical variables, and non-parametric Wilcoxon ranked sum test or student's t-test for continuous variables. RESULTS: Participants were largely located in pneumoconiosis mortality hotspots of the USA. In a convenience sample of 70 participants, clinical professional groups such as clinicians (29%), home health professionals (20%) and respiratory therapists (17%) constituted the majority of the stakeholders. Participants demonstrated the lowest knowledge score on 'legal pneumoconiosis' among the knowledge areas questioned; reported low self-efficacy with respect to managing miners' conditions and interpreting test results; and rated the learning community highly in terms of trust (86%), willingness to help each other (93%) and being closely knit (87%). Analysis of knowledge sources indicated that participants receive substantial proportions of knowledge from individuals outside of their stakeholder and professional groups, but proportions differ among clinical and non-clinical professional groups, as well as among 'fresh' and existing participants. CONCLUSION: The present study demonstrates the successful creation of a virtual multidisciplinary community of practice in pneumoconiosis mortality hotspot rural regions of the USA, with participants reporting multidisciplinary knowledge transfer. The community is regarded highly by participants in relation to trust, willingness to help and being closely knit. This innovative educational approach may help ensure the delivery of high-quality interdisciplinary care to rural miners in pneumoconiosis mortality hotspots in the USA.
