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

Slatore, Christopher G.; Horeweg, Nanda; Jett, James R.; Midthun, David E.; Powell, Charles A.; Wiener, Renda Soylemez; Wisnivesky, Juan P.; Gould, Michael K.

doi:10.1164/rccm.201506-1082st

Cited by 32 publications

(21 citation statements)

References 84 publications

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“…It is unknown whether patients undergoing screening in a “real world” setting will experience the same low levels of distress observed in clinical trials or the higher distress observed in this and other observational studies of patients with incidental nodules in usual practice. As called for in a recent statement of the American Thoracic Society, 11 studies examining distress as lung cancer screening is implemented into usual practice are urgently needed.…”

Section: Discussionmentioning

confidence: 99%

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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: 99%

“…Recognizing the increasing emphasis on patient-centered care and the growing numbers of patients with pulmonary nodules, the American Thoracic Society recently called for more research to explore the impact of nodule detection on patients. 11 …”

Section: Introductionmentioning

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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“…The ATS has identified a need for research to establish which structures and processes most effectively improve outcomes of patients with pulmonary nodules so that facilities know how best to invest limited resources (10). As lung cancer screening is implemented, these studies are all the more urgently needed to assure appropriate resources are in place to facilitate pulmonary nodule evaluation.…”

Section: Discussionmentioning

confidence: 89%

“…Systems-level structures and processes of care have been proposed to facilitate appropriate, efficient nodule evaluation (4)(5)(6)(7)(8), and indeed, clinicians have indicated that such system-level resources are essential to avoid loss to follow-up (9). However, the degree to which these structures and processes of care have been implemented nationally is unclear, and the American Thoracic Society (ATS) has called for more research in this area (10). We conducted a survey of ATS clinicians to characterize the availability of system-level resources to facilitate pulmonary nodule evaluation in the United States.…”

Section: Systems-level Resources For Pulmonary Nodule Evaluation In Tmentioning

confidence: 93%

Systems-Level Resources for Pulmonary Nodule Evaluation in the United States: A National Survey

Simmons

Gould

Iaccarino

et al. 2016

Am J Respir Crit Care Med

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“…One barrier to investigating lung nodule care delivery and associated outcomes is the inability to reliably identify a cohort of individuals with an incidentally detected lung nodule 8. The International Classification of Disease, Ninth Revision (ICD-9) diagnostic codes are inaccurate,9 and manual abstraction of data from free-text radiology reports is time intensive and expensive.…”

Section: Introductionmentioning

confidence: 99%

An Automated Method for Identifying Individuals with a Lung Nodule Can Be Feasibly Implemented Across Health Systems

Farjah¹,

Halgrim²,

Buist³

et al. 2016

eGEMs

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Introduction:The incidence of incidentally detected lung nodules is rapidly rising, but little is known about their management or associated patient outcomes. One barrier to studying lung nodule care is the inability to efficiently and reliably identify the cohort of interest (i.e. cases). Investigators at Kaiser Permanente Southern California (KPSC) recently developed an automated method to identify individuals with an incidentally discovered lung nodule, but the feasibility of implementing this method across other health systems is unknown.Methods:A random sample of Group Health (GH) members who had a computed tomography in 2012 underwent chart review to determine if a lung nodule was documented in the radiology report. A previously developed natural language processing (NLP) algorithm was implemented at our site using only knowledge of the key words, qualifiers, excluding terms, and the logic linking these parameters.Results:Among 499 subjects, 156 (31%, 95% confidence interval [CI] 27–36%) had an incidentally detected lung nodule. NLP identified 189 (38%, 95% CI 33–42%) individuals with a nodule. The accuracy of NLP at GH was similar to its accuracy at KPSC: sensitivity 90% (95% CI 85–95%) and specificity 86% (95% CI 82–89%) versus sensitivity 96% (95% CI 88–100%) and specificity 86% (95% CI 75–94%).Conclusion:Automated methods designed to identify individuals with an incidentally detected lung nodule can feasibly and independently be implemented across health systems. Use of these methods will likely facilitate the efficient conduct of multi-site studies evaluating practice patterns and associated outcomes.

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

Cited by 32 publications

References 84 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

Systems-Level Resources for Pulmonary Nodule Evaluation in the United States: A National Survey

An Automated Method for Identifying Individuals with a Lung Nodule Can Be Feasibly Implemented Across Health Systems

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