TY - JOUR
T1 - Primary care providers and a system problem a qualitative study of clinicians caring for patients with incidental pulmonary nodules
AU - Golden, Sara E.
AU - Wiener, Renda Soylemez
AU - Sullivan, Donald
AU - Ganzini, Linda
AU - Slatore, Christopher
PY - 2015/12
Y1 - 2015/12
N2 - BACKGROUND: As lung cancer screening with low-dose CT scanning is implemented, an increasing number of people will be diagnosed with pulmonary nodules. Primary care clinicians care for the vast majority of these patients, but their experiences with communication and managing distress in this population are not well understood. METHODS: We conducted qualitative interviews of 15 primary care providers (PCPs) at two academic medical centers who care for patients with pulmonary nodules. We used qualitative description analysis, focusing on clinicians' information exchange and other communication behaviors. RESULTS: Most PCPs believed they had inadequate information to counsel patients regarding lung nodules, although this information is desired. PCPs were concerned patients could "fall through the cracks" but did not have access to a reliable system to ensure follow-up adherence. Th ey were limited by time, knowledge, and resources in providing the preferred level of care. Most PCPs did not discuss the specifi c risk a nodule was lung cancer, in part because they did not have ready access to this information. PCPs believed most patients did not have substantial distress as a result of nodule detection. Most PCPs did not include patients when making decisions about the follow-up plan. CONCLUSIONS: PCPs oft en lack systemic resources to optimize patient-centered approaches when discussing incidental pulmonary nodules with patients. With the advent of lung cancer screening, pulmonologists can assist primary care colleagues by providing accurate information to counsel patients and assisting in managing conversations about the risk of cancer. Pulmonologists should support eff orts to implement reliable systems to ensure adherence to follow-up.
AB - BACKGROUND: As lung cancer screening with low-dose CT scanning is implemented, an increasing number of people will be diagnosed with pulmonary nodules. Primary care clinicians care for the vast majority of these patients, but their experiences with communication and managing distress in this population are not well understood. METHODS: We conducted qualitative interviews of 15 primary care providers (PCPs) at two academic medical centers who care for patients with pulmonary nodules. We used qualitative description analysis, focusing on clinicians' information exchange and other communication behaviors. RESULTS: Most PCPs believed they had inadequate information to counsel patients regarding lung nodules, although this information is desired. PCPs were concerned patients could "fall through the cracks" but did not have access to a reliable system to ensure follow-up adherence. Th ey were limited by time, knowledge, and resources in providing the preferred level of care. Most PCPs did not discuss the specifi c risk a nodule was lung cancer, in part because they did not have ready access to this information. PCPs believed most patients did not have substantial distress as a result of nodule detection. Most PCPs did not include patients when making decisions about the follow-up plan. CONCLUSIONS: PCPs oft en lack systemic resources to optimize patient-centered approaches when discussing incidental pulmonary nodules with patients. With the advent of lung cancer screening, pulmonologists can assist primary care colleagues by providing accurate information to counsel patients and assisting in managing conversations about the risk of cancer. Pulmonologists should support eff orts to implement reliable systems to ensure adherence to follow-up.
UR - http://www.scopus.com/inward/record.url?scp=84949033247&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84949033247&partnerID=8YFLogxK
U2 - 10.1378/chest.14-2938
DO - 10.1378/chest.14-2938
M3 - Article
C2 - 25790082
AN - SCOPUS:84949033247
SN - 0012-3692
VL - 148
SP - 1422
EP - 1429
JO - CHEST
JF - CHEST
IS - 6
ER -