Use of a Clinical Pathway To Manage Unsuspected Radiographic Findings

Holden, William E.; Lewinsohn, David; Osborne, Molly L.; Griffin, Chris; Spencer, A.; Duncan, Carol; Deffebach, Mark

doi:10.1378/chest.125.5.1753

Cited by 25 publications

(25 citation statements)

References 10 publications

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“…At the PVAMC, thoracic radiology images with nodules are electronically flagged (2). In general, primary care providers are responsible for notifying the patient and determining the evaluation, usually without guidance from pulmonologists.…”

Section: Overview and Settingmentioning

confidence: 99%

“…Every year, hundreds of thousands of patients are diagnosed with incidental pulmonary nodules (1,2), fueled by the large and growing number of patients who undergo radiologic imaging studies (3)(4)(5)(6). The number of patients with pulmonary nodules is likely to substantially increase, as multiple organizations, including the U.S. Preventive Services Task Force, now recommend annual low-dose computed tomography (CT) screening for adults at high risk of developing lung cancer (7)(8)(9)(10)(11)(12).…”

mentioning

confidence: 99%

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Distress and Patient-Centered Communication among Veterans with Incidental (Not Screen-Detected) Pulmonary Nodules. A Cohort Study

et al. 2015

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Rationale: Incidental pulmonary nodule detection is postulated to cause distress, but the frequency and magnitude of that distress have not been reported. The quality of patient-clinician communication and the perceived risk of lung cancer may influence distress Objectives: To evaluate the association of communication processes with distress and the perceived risk of lung cancer using validated instruments. Methods:We conducted a prospective cohort study of patients with incidentally detected nodules who received care at one Department of Veterans Affairs Medical Center. We measured distress with the Impact of Event Scale and patient-centered communication with the Consultation Care Measure, both validated instruments. Risk of lung cancer was self-reported by participants. We used multivariable adjusted logistic regression to measure the association of communication quality with distress.Measurements and Main Results: Among 122 Veterans with incidental nodules, 23%, 12%, and 4% reported experiencing mild, moderate, and severe distress, respectively, at the time they were informed of the pulmonary nodule. Participant-reported risk of lung cancer was not associated with distress. In the adjusted model, high-quality communication was associated with decreased distress (odds ratio [OR] = 0.28, 95% confidence interval [CI] = 0.08-1.00, P = 0.05). Among participants who reported a risk of malignancy of 30% or less, high-quality communication was associated with decreased distress (OR = 0.15, 95% CI = 0.02-0.92, P = 0.04), but was not associated with distress for those who reported a risk greater than 30% (OR = 0.12 (95% CI = 0.00-3.97, P = 0.24), although the P value for interaction was not significant. Conclusions:Veterans with incidental pulmonary nodules frequently reported inadequate information exchange regarding their nodule. Many patients experience distress after they are informed that they have a pulmonary nodule, and high-quality patient-clinician communication is associated with decreased distress. Communication strategies that only target improved knowledge of the risk of malignancy may not be sufficient to reduce the distress associated with nodule detection.

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Section: Overview and Settingmentioning

confidence: 99%

mentioning

confidence: 99%

Distress and Patient-Centered Communication among Veterans with Incidental (Not Screen-Detected) Pulmonary Nodules. A Cohort Study

et al. 2015

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“…Hundreds of thousands of patients are diagnosed every year with incidental pulmonary nodules (1)(2)(3), fueled by the everincreasing number of individuals who undergo imaging studies (4)(5)(6)(7). The number of patients with pulmonary nodules will increase, because multiple organizations, including the American Thoracic Society (ATS), recommend annual low-dose computed tomography (CT) screening for adults at high risk of developing lung cancer (8)(9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

An Official American Thoracic Society Research Statement: A Research Framework for Pulmonary Nodule Evaluation and Management

Slatore¹,

Horeweg²,

Jett³

et al. 2015

Am J Respir Crit Care Med

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“…2 Similarly, at the time of interviews, BUMC did not consistently use a registry for nodule notification or monitoring follow-up adherence. At each site, PCPs received a letter inviting them to participate in one qualitative interview.…”

Section: Overview and Settingmentioning

confidence: 99%

“…1,2 More patients with nodules will be detected, since lung cancer screening using low-dose CT scanning is now widely recommended and anticipated to increase. [3][4][5][6][7] Although some patients enrolled in lung cancer screening trials have shown an increase in negative psychosocial outcomes such as distress and anxiety, fi ndings are inconsistent.…”

mentioning

confidence: 99%