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Original Research: Lung Cancer |

Primary Care Providers and a System ProblemPrimary Care Experience With Pulmonary Nodules: A Qualitative Study of Clinicians Caring for Patients With Incidental Pulmonary Nodules

Sara E. Golden, MPH; Renda Soylemez Wiener, MD, MPH; Donald Sullivan, MD; Linda Ganzini, MD, MPH; Christopher G. Slatore, MD
Author and Funding Information

From the Health Services Research and Development (Ms Golden and Drs Sullivan, Ganzini, and Slatore), and the Section of Pulmonary and Critical Care Medicine (Dr Slatore), VA Portland Health Care System, Portland, OR; the Center for Healthcare Organization and Implementation Research (Dr Wiener), Edith Nourse Rogers Memorial VA Hospital, Bedford, MA; The Pulmonary Center (Dr Wiener), Boston University School of Medicine, Boston, MA; and the Division of Geriatric Medicine (Drs Sullivan and Ganzini), Department of Psychiatry, and the Division of Pulmonary and Critical Care Medicine (Dr Slatore), Department of Medicine, Oregon Health and Science University, Portland, OR.

CORRESPONDENCE TO: Sara E. Golden, MPH, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, R&D 66, Portland, OR 97239; e-mail: sara.golden1@va.gov


FOR EDITORIAL COMMENT SEE PAGE 1365

SEE RELATED ARTICLES PAGES 1405 AND 1415

Presented, in part, as an abstract at the Society of Clinical Research Associates Conference, September 19-21, 2014, Orlando, FL.

FUNDING/SUPPORT: This study and Dr Slatore are supported by a VA Health Services Research and Development Career Development Award [CDP 11-227]. Dr Wiener was supported by the National Cancer Institute [Grant K07 CA138772]. Dr Sullivan is supported by the National Institutes of Health and National Center for Research Resources through the Oregon Health and Science University Oregon Clinical and Translational Research Institute [Grant 5KL2TR000152-08]. It was also supported by resources from the VA Portland Health Care System, Portland, OR, and the Edith Nourse Rogers Memorial VA Hospital, Bedford, MA.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(6):1422-1429. doi:10.1378/chest.14-2938
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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. They were limited by time, knowledge, and resources in providing the preferred level of care. Most PCPs did not discuss the specific 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 often 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 efforts to implement reliable systems to ensure adherence to follow-up.


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