Clinical Equipoise and Shared Decision-making in Pulmonary Nodule Management. A Survey of American Thoracic Society Clinicians

Iaccarino, Jonathan M.; Simmons, James A.; Gould, Michael K.; Slatore, Christopher G.; Woloshin, Steven; Schwartz, Lisa M.; Wiener, Renda Soylemez

doi:10.1513/annalsats.201609-727oc

Cited by 23 publications

(16 citation statements)

References 36 publications

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“…Future work should also strive to gain an understanding of whether surgeon preferences regarding their and their patients’ roles in decision making vary over the course of a surgeon’s career. One may speculate that surgeons prefer to be more directive in patient counseling as their careers and level of experience progress, but there has been limited investigation into whether such a trend exists [ 50 ]. A more robust understanding of surgeon preferences would aid in the development of clinical counseling training programs for junior surgeons and trainees as well as continuing medical education programs for senior surgeons.…”

Section: Discussionmentioning

confidence: 99%

Shared decision making in surgery: a scoping review of patient and surgeon preferences

Shinkunas

Klipowicz

Carlisle

2020

BMC Med Inform Decis Mak

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Background Many suggest that shared decision-making (SDM) is the most effective approach to clinical counseling. It is unclear if this applies to surgical decision-making-especially regarding urgent, highly-morbid operations. In this scoping review, we identify articles that address patient and surgeon preferences toward SDM in surgery. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) to develop our protocol. Medline, EMBASE, and Cochrane databases were searched from inception through 11.2017. Title/abstract review identified peer-reviewed, empirical articles that addressed patient/surgeon preferences toward SDM in surgery. Identified articles underwent full review by two independent investigators. We addressed the following questions: (1) What is known from existing empirical evidence about patients’ and/or surgeons’ surgical decision-making preferences? (2) Why might patients and/or surgeons prefer SDM? (3) Does acuity of intervention impact surgical decision-making preferences? Outcome measures included study methods, surgical specialty, diagnosis, study location/setting, type/number of subjects, acuity of intervention, surgeon/patient decision-making preferences, and factors associated with favoring SDM. Data was analyzed in Microsoft Excel. Results 20,359 articles were identified with 4988 duplicates, yielding 15,371 articles for title/abstract review. 74 articles were included in final analysis. 68% of articles discussed oncologic decision-making. 46% of these focused on breast cancer. 92% of articles included patients, 22% included surgeons. 75% of articles found surgeons favored SDM, 25% demonstrated surgeons favored surgeon guidance. 54% of articles demonstrated patients favored SDM, 35% showed patients favored surgeon guidance, 11% showed patients preferred independent decision-making. The most common factors for patients favoring SDM included female gender, higher education, and younger age. For surgeons, the most common factors for favoring SDM included limited evidence for a given treatment plan, multiple treatment options, and impact on patient lifestyle. No articles evaluated decision-making preferences in an emergent setting. Conclusions There has been limited evaluation of patient and surgeon preferences toward SDM in surgical decision-making. Generally, patients and surgeons expressed preference toward SDM. None of the articles evaluated decision-making preferences in an emergent setting, so assessment of the impact of acuity on decision-making preferences is limited. Extension of research to complex, emergent clinical settings is needed.

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Section: Discussionmentioning

confidence: 99%

Shared decision making in surgery: a scoping review of patient and surgeon preferences

Shinkunas

Klipowicz

Carlisle

2020

BMC Med Inform Decis Mak

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“…Previous studies have also reported that radiologist's diagnosis as a means for predicting malignancy in pulmonary nodules is more accurate than nodule classification models (29,30). However, this does not mean that the models are limited use.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Veterans Affairs, Mayo, Brock classification models and radiologist diagnosis for classifying the malignancy of pulmonary nodules in Chinese clinical population

Cui¹,

Heuvelmans²,

Han³

et al. 2019

Transl. Lung Cancer Res.

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Comparison of Veterans Affairs, Mayo, Brock classification models and radiologist diagnosis for classifying the malignancy of pulmonary nodules in Chinese clinical population . (2019). Comparison of Veterans Affairs, Mayo, Brock classification models and radiologist diagnosis for classifying the malignancy of pulmonary nodules in Chinese clinical population. Translational lung cancer research, 8(5), 605-613. Background: Several classification models based on Western population have been developed to help clinicians to classify the malignancy probability of pulmonary nodules. However, the diagnostic performance of these Western models in Chinese population is unknown. This paper aimed to compare the diagnostic performance of radiologist evaluation of malignancy probability and three classification models (Mayo Clinic, Veterans Affairs, and Brock University) in Chinese clinical pulmonology patients. Methods: This single-center retrospective study included clinical patients from Tianjin Medical University Cancer Institute and Hospital with new, CT-detected pulmonary nodules in 2013. Patients with a nodule with diameter of 4-25 mm, and histological diagnosis or 2-year follow-up were included. Analysis of area under the receiver operating characteristic curve (AUC), decision curve analysis (DCA) and threshold of decision analysis was used to evaluate the diagnostic performance of radiologist diagnosis and the three classification models, with histological diagnosis or 2-year follow-up as the reference. Results: In total, 277 patients (286 nodules) were included. Two hundred and seven of 286 nodules (72.4%) in 203 patients were malignant. AUC of the Mayo model (0.77; 95% CI: 0.72-0.82) and Brock model (0.77; 95% CI: 0.72-0.82) were similar to radiologist diagnosis (0.78; 95% CI: 0.73-0.83; P=0.68, P=0.71, respectively). The diagnostic performance of the VA model (AUC: 0.66) was significantly lower than that of radiologist diagnosis (P=0.003). A three-class classifying threshold analysis and DCA showed that the radiologist evaluation had higher discriminatory power for malignancy than the three classification models. Conclusions: In a cohort of Chinese clinical pulmonology patients, radiologist evaluation of lung nodule malignancy probability demonstrated higher diagnostic performance than Mayo, Brock, and VA classification models. To optimize nodule diagnosis and management, a new model with more radiological characteristics could be valuable. of Veterans Affairs, Mayo, Brock classification models and radiologist diagnosis for classifying the malignancy of pulmonary nodules in Chinese clinical population. Transl Lung Cancer Res 2019;8(5):605-613.

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“…Peripheral pulmonary lesions have become one of the major incidental findings during lung screening by computed tomography (CT) . A survey of American Thoracic Society Clinicians of pulmonary nodule management showed that the number of clinicians that recommended surgical resection as appropriate increased with cancer risk . There are several methods to localize the nodules before diagnostic surgery, especially for impalpable or ground glass opacities.…”

Section: Introductionmentioning

confidence: 99%

Vectorial localization of peripheral pulmonary lesion guided by electromagnetic navigation: A novel method for diagnostic surgical resection without dye marking

Qiu

Xuan

et al. 2018

Thoracic Cancer

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We describe a novel method using electromagnetic navigation bronchoscopy (ENB) without dye marking to perform vectorial localization for an impalpable peripheral lesion in the right lower lobe during diagnostic surgical resection in a 52‐year‐old woman. After the ENB registration process, the anesthetist changed the single‐lumen endotracheal tube to a double‐lumen endobronchial tube. Guided by the ENB system, the operator delivered the probe of the locatable guide to the planned site through the right lumen of the endobronchial tube. The ENB system allows calculation of the direction and distance between the probe and the lesion, confirming the relative location of the lesion. The locatable guide was retained during surgery as an intraoperative indicator, rather than applying dye marking. During video‐assisted thoracoscopic surgery, the protuberant visceral pleura poked by the probe accurately indicated the relative location of the lesion. Accordingly, we performed precise wedge resection for diagnosis, followed by lobectomy, resulting in a diagnosis of invasive adenocarcinoma. Vectorial localization is an alternative method of ENB‐guided localization to peripheral pulmonary lesions, which can provide the accurate location of such lesions for diagnostic surgical resection.

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Clinical Equipoise and Shared Decision-making in Pulmonary Nodule Management. A Survey of American Thoracic Society Clinicians

Cited by 23 publications

References 36 publications

Shared decision making in surgery: a scoping review of patient and surgeon preferences

Shared decision making in surgery: a scoping review of patient and surgeon preferences

Comparison of Veterans Affairs, Mayo, Brock classification models and radiologist diagnosis for classifying the malignancy of pulmonary nodules in Chinese clinical population

Vectorial localization of peripheral pulmonary lesion guided by electromagnetic navigation: A novel method for diagnostic surgical resection without dye marking

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