Original Research |

“What do you mean, a spot?”: A qualitative analysis of patients’ reactions to discussions with their doctors about pulmonary nodules FREE TO VIEW

Renda Soylemez Wiener, MD, MPH; Michael K. Gould, MD, MS; Steven Woloshin, MD, MS; Lisa M. Schwartz, MD, MS; Jack A. Clark, PhD
Author and Funding Information

Author Affiliations: From the Pulmonary Center, Boston University School of Medicine, Boston, MA (Dr. Wiener); Center for Health Quality, Outcomes and Economic Research, ENRM VA Hospital, Bedford, MA (Drs. Wiener and Clark); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (Dr. Gould); VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT (Drs. Woloshin and Schwartz); The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH (Drs. Woloshin and Schwartz); Department of Health Policy & Management, Boston University School of Public Health, Boston, MA (Dr. Clark).

Correspondence to: Renda Soylemez Wiener, MD, MPH at The Pulmonary Center, Boston University School of Medicine, 72 E. Concord Street, R-304, Boston, MA 02118; email: rwiener@bu.edu

Copyright © 2012 American College of Chest Physicians

Chest. 2012. doi:10.1378/chest.12-1095
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Background:  Over 150,000 Americans each year are found to have a pulmonary nodule. Even more will be affected following the publication of the National Lung Screening Trial. Patient-doctor communication about pulmonary nodules can be challenging: most are benign but some are malignant, and it may take 2-3 years to rule out cancer. We sought to characterize patients' perceptions of communication with their providers about pulmonary nodules.

Methods:  We conducted 4 focus groups at 2 sites with 22 adults with an indeterminate pulmonary nodule. Transcripts were analyzed using principles of grounded theory.

Results:  Patients described conversations with 53 different providers about the pulmonary nodule. Almost all patients immediately assumed they had cancer when first told about the nodule. Some patients whose providers did not discuss the actual cancer risk or explain the evaluation plan experienced confusion and distress that sometimes lasted months. Patients were frustrated when their providers did not address their concerns about cancer or potential adverse effects of surveillance (e.g., prolonged uncertainty, radiation exposure), which in some cases led to poor adherence. Patients found it helpful when doctors used lay terms, showed the CT image, and quantified cancer risk; by contrast, patients resented medical jargon and dismissive language.

Conclusions:  Patients commonly assume that a pulmonary nodule means cancer. What providers tell (or don’t tell) patients about their cancer risk and the evaluation plan can strongly influence patients’ perceptions of the nodule and related distress. We describe simple communication strategies that may help patients come to terms with an indeterminate pulmonary nodule.

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