Primary Care Providers and a System Problem

Golden, Sara E.; Wiener, Renda Soylemez; Sullivan, Donald R.; Ganzini, Linda; Slatore, Christopher G.

doi:10.1378/chest.14-2938

Cited by 50 publications

(9 citation statements)

References 37 publications

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“…Indeed, clinicians themselves have reported they often do not supply cancer risk information or even discuss cancer at all for fear of worrying patients with incidental nodules. 40,41 However, those patients in our survey who reported receiving cancer risk estimates more often found this information reassuring rather than scary, perhaps because the actual risk was much lower than the patients’ assumption of what their risk might be. 3,8,9 Another possibility, however, is that clinicians did provide cancer risk information but that patients were too overwhelmed by news of a nodule to process this information.…”

Section: Discussionmentioning

confidence: 81%

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Patients’ Knowledge, Beliefs, and Distress Associated with Detection and Evaluation of Incidental Pulmonary Nodules for Cancer: Results from a Multicenter Survey

Freiman

Clark

Slatore

et al. 2016

Journal of Thoracic Oncology

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Introduction Pulmonary nodules are detected in over a million Americans each year. Prior qualitative work suggests the detection of incidental pulmonary nodules can be burdensome for patients, but it is unknown whether these findings generalize to a broader sample of patients. We categorized patients’ knowledge, beliefs, and distress associated with detection and evaluation of a pulmonary nodule, and their impressions of clinician communication. Methods We administered a cross-sectional survey to adults with an incidental pulmonary nodule recruited from a rural medical center, an urban safety net hospital, and a Veterans Affairs hospital. Results Of 490 surveys mailed, 244 (50%) responded. Median nodule size was 7 mm; mean patient age was 67 years; 29% were female, and 86% were white. A quarter (26%) of respondents reported clinically significant distress related to their nodule as measured by the Impact of Event scale, our primary outcome. Patients reported multiple concerns including uncertainty about the nodule’s etiology (78%), the possibility of cancer (73%), and the possible need for surgery (64%). Only 25% of patients accurately estimated their lung cancer risk (within 15% of their actual risk); overall there was no correlation between perceived and actual risk (r=−0.007, p=0.93). Among the 23% of patients who did receive cancer risk information from their provider, they were more likely to find this information reassuring (16%) than scary (7%). Conclusion A quarter of patients with incidental pulmonary nodules experienced clinically significant distress. Knowledge about cancer risk and evaluation was poor. Clinician communication may help bridge knowledge gaps and alleviate distress in some patients.

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Section: Discussionmentioning

confidence: 81%

“…Similarly, our study confirms that patients want to be involved in shared decision-making about nodule evaluation, far more than they typically are. 7,40,41 …”

Section: Discussionmentioning

confidence: 99%

Patients’ Knowledge, Beliefs, and Distress Associated with Detection and Evaluation of Incidental Pulmonary Nodules for Cancer: Results from a Multicenter Survey

Freiman

Clark

Slatore

et al. 2016

Journal of Thoracic Oncology

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“…Consequently, PN evaluation has the potential to create a tremendous burden on individual patients and the health care system. It is essential that these patients be evaluated by clinicians experienced in dealing with and treating these nodules [11-12]. There are data that PNCs and lung cancer screening programs expedite the evaluation and treatment of lung cancer [10, 13].…”

Section: Discussionmentioning

confidence: 99%

A Community-based Pulmonary Nodule Clinic: Improving Lung Cancer Stage at Diagnosis

Melton

Lazar

Moritz

2019

Cureus

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Objective Pulmonary nodules (PNs) are a common incidental finding and are often how lung cancer is discovered. Our goal was to determine if establishing a pulmonary nodule clinic (PNC) in a community healthcare setting would lead to an earlier stage at diagnosis. Methods A single healthcare system retrospective review was conducted of all PNC patients from 2010-2015 diagnosed with lung cancer. The stage at diagnosis was analyzed and compared to lung cancer patients in our healthcare system outside the PNC and to national data. Five-year survival rates for PNC patients from 2010-2012 were also analyzed. Results A total of 119 patients and 127 lung cancers were diagnosed through the PNC from 2010-2015. There were 990 lung cancers, with a known stage, diagnosed outside the PNC in our healthcare system from 2010 to 2015. Two hundred and eighty one (28.4%) cancers were Stage I, compared to 69 (54.3%) (p <0.0001) through the PNC; 110 (11.1%) cancers were diagnosed at Stage II compared to 17 (13.4%) through the PNC (0.4471); 277 (25.7%) cancers were diagnosed at Stage III, compared to 21 (16.5%) through the PNC (p 0.0060); 598 (60.4%) cancers were diagnosed at Stage IV, compared to 20 (15.7%) through the PNC (p <0.0001). Five-year survival rates for patients diagnosed in 2010 were 80% (four of five patients), 79.2% (19/24) in 2011, and 62.2% (23/37) in 2012. Conclusions Lung cancer survival is directly related to the stage at diagnosis. Establishment of our PNC has led to an earlier stage at diagnosis compared to the general lung cancer population in our community.

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“…In order to understand and improve decision-making around incidental imaging findings, patient perceptions and preferences must be studied. While patients have reported wanting to engage in shared decision-making regarding common incidental findings such as lung nodules (9), the process can pose challenges. One particular obstacle to decision-making for patients is the method used for communicating the risks associated with medical tests.…”

Section: Introductionmentioning

confidence: 99%

“…Routine communication of risk to patients regarding incidental findings on imaging is variable and non-standardized, with some reports of verbal descriptions (e.g. probably, most likely), or even possibly no discussion of risk (9–11). Previous studies in other clinical contexts have shown that to improve risk communication for patients, graphical representation of probabilities and simplified language should be employed (12, 13).…”

Section: Introductionmentioning

confidence: 99%

A Randomized Study of Patient Risk Perception for Incidental Renal Findings on Diagnostic Imaging Tests

Kang

Scherer

Megibow

et al. 2018

American Journal of Roentgenology

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Primary Care Providers and a System Problem

Cited by 50 publications

References 37 publications

Patients’ Knowledge, Beliefs, and Distress Associated with Detection and Evaluation of Incidental Pulmonary Nodules for Cancer: Results from a Multicenter Survey

Patients’ Knowledge, Beliefs, and Distress Associated with Detection and Evaluation of Incidental Pulmonary Nodules for Cancer: Results from a Multicenter Survey

A Community-based Pulmonary Nodule Clinic: Improving Lung Cancer Stage at Diagnosis

A Randomized Study of Patient Risk Perception for Incidental Renal Findings on Diagnostic Imaging Tests

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