Chest
Original ResearchLung CancerWhat Do You Mean, a Spot?: A Qualitative Analysis of Patients' Reactions to Discussions With Their Physicians About Pulmonary Nodules
Section snippets
Materials and Methods
We recruited participants from Boston Medical Center (which serves a racially diverse, economically disadvantaged urban population) and Dartmouth-Hitchcock Medical Center (a referral center for a rural population of mixed socioeconomic status). We identified English-speaking adults with an indeterminate pulmonary nodule by soliciting names from pulmonary and primary-care providers, reviewing referrals to pulmonary clinics, and searching problem lists and CT imaging reports (e-Table 1). Eligible
Results
Patients described conversations about their nodule with 53 providers from academic and community practices, including primary-care providers, pulmonologists, and thoracic surgeons. The involvement of multiple clinicians most often stemmed from referral by the provider first faced with an incidental nodule (eg, ED physician) to the primary-care provider, often followed by a second referral to a pulmonologist. Table 1 shows the characteristics of the study patients.
Discussion
This study is the first to our knowledge to provide data on provider-patient communication about pulmonary nodules, offering insight into patients' experiences through their own words. Study patients described both satisfying and frustrating conversations. From their accounts, we identified patient-important communication elements; formulated them into seven questions that providers might consider in framing discussions about a nodule; and identified specific, patient-endorsed strategies that
Acknowledgments
Author contributions: Dr Wiener had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Wiener: contributed to the conception, hypotheses delineation, and design of the study; data acquisition, analysis, and interpretation; and writing and revision of the article prior to submission.
Dr Gould: contributed to the conception, hypotheses delineation, and design of the study; data acquisition, analysis, and
References (44)
- et al.
Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition)
Chest
(2007) - et al.
Evaluation of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition)
Chest
(2007) - et al.
Are we there yet? The state of the evidence base for guidelines on breaking bad news to cancer patients
Eur J Cancer
(2009) - et al.
Communicating prognosis in cancer care: a systematic review of the literature
Ann Oncol
(2005) - et al.
The incidence of pulmonary neoplasms discovered by serial computed tomography scanning after endovascular abdominal aortic aneurysm repair
J Vasc Surg
(2011) Management of the solitary pulmonary nodule: directed resection
Semin Thorac Cardiovasc Surg
(2002)- et al.
Beliefs among physicians in the diagnostic and therapeutic approach to non-small cell lung cancer
J Thorac Oncol
(2007) - et al.
Follow-up of abnormal screening mammograms among low-income ethnically diverse women: findings from a qualitative study
Patient Educ Couns
(2008) - et al.
Using the word ‘cancer’ in communication about an abnormal Pap test: finding common ground with patient-provider communication
Patient Educ Couns
(2010) - et al.
Clinical practice. The solitary pulmonary nodule
N Engl J Med
(2003)
Reduced lung-cancer mortality with low-dose computed tomographic screening
N Engl J Med
Screening for lung cancer: it works, but does it really work?
Ann Intern Med
Population-based risk for complications after transthoracic needle lung biopsy of a pulmonary nodule: an analysis of discharge records
Ann Intern Med
Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society
Radiology
Shared decision making in patients with pulmonary nodules. In: Pulmonary, Critical Care, and Sleep Update. American College of Chest Physicians website
Basics of Qualitative Research: Grounded Theory Procedures and Techniques
Qualitative Data Analysis: An Expanded Sourcebook
Probability of malignancy in SPN: Bayesian analysis. Chest X-ray website
A patient-centered approach to breaking bad news: communication guidelines for health care providers
J Appl Commun Res
Breaking bad news. A review of the literature
JAMA
How should doctors communicate the diagnosis of cancer to patients?
Ann Med
Breaking bad news: consensus guidelines for medical practitioners
J Clin Oncol
Cited by (113)
Use of seven types of medical jargon by male and female primary care providers at a university health center
2022, Patient Education and CounselingCitation Excerpt :Among studies that have explicitly investigated patient responses to jargon, researchers have found that patients have difficulty recalling jargon [11,14]. They may interpret use of difficult terms as providers’ avoiding explaining what the real problem is [33], and they may resent providers for not communicating more clearly [23]. Given that jargon use is associated with lower recall of information, it is also possible that when providers use a lot of jargon, patients have less self-efficacy than they do when providers explain terms clearly.
Nodule net: A centralized prospective lung nodule tracking and safety-net program
2022, Respiratory MedicineMultidisciplinary virtual management of pulmonary nodules
2022, PulmonologyPatient vs Clinician Perspectives on Communication About Results of Lung Cancer Screening: A Qualitative Study
2020, ChestCitation Excerpt :Possibly their preferences and perceptions may differ from non-veteran participants, although we did not find substantial differences in patient perceptions across VA and non-VA sites. Moreover, prior studies of patient experiences of and preferences for incidental pulmonary nodule disclosure found similar results among veteran and non-veteran participants.10,11,13 To address these limitations, we are conducting a multi-center prospective study to assess perceived quality of communication before, during, and after LCS in diverse real-world settings, including surveys to quantify subsequent patient-centered outcomes, including distress.44
Funding/Support: This study is funded by a career development award from the National Cancer Institute [K07 CA138772]. Dr Gould is supported by the National Cancer Institute. Drs Wiener, Woloshin, Schwartz, and Clark receive salary support from the Department of Veterans Affairs.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.