Pulmonologists' Reported Use of Guidelines and Shared Decision-making in Evaluation of Pulmonary Nodules: A Qualitative Study

Chest
Renda Soylemez WienerJack A Clark

Abstract

Selecting a strategy (surveillance, biopsy, resection) for pulmonary nodule evaluation can be complex given the absence of high-quality data comparing strategies and the important tradeoffs among strategies. Guidelines recommend a three-step approach: (1) assess the likelihood of malignancy, (2) evaluate whether the patient is a candidate for invasive intervention, and (3) elicit the patient's preferences and engage in shared decision-making. We sought to characterize how pulmonologists select a pulmonary nodule evaluation strategy and the extent to which they report following the guideline-recommended approach. We conducted semistructured qualitative interviews with 14 pulmonologists who manage patients with pulmonary nodules at four clinical sites. Transcripts of audiorecorded interviews were analyzed using the principles of grounded theory. Pulmonologists reported consistently performing steps 1 and 2 but described diverse approaches to step 3 that ranged from always engaging the patient in decision-making to never doing so. Many described incorporating patients' preferences only in particular circumstances, such as when the patient appeared particularly anxious or was aggressive in questioning management options. Indeed, ot...Continue Reading

References

Aug 1, 1990·The American Journal of Medicine·H S PerkinsJ D Schoolfield
Dec 23, 1999·Psycho-oncology·J R DavidsonD Feldman-Stewart
Nov 23, 2006·Scandinavian Journal of Primary Health Care·Luan Coar, Julius Sim
Nov 20, 2009·Implementation Science : IS·Glyn ElwynStephen Rollnick
Jun 17, 2010·JAMA : the Journal of the American Medical Association·Samuel CykertAudrina Jones Bunton
Sep 14, 2010·Journal of Evaluation in Clinical Practice·Mary C Politi, Richard L Street
Sep 24, 2010·Health Expectations : an International Journal of Public Participation in Health Care and Health Policy·Mary C PolitiGlyn Elwyn
Sep 28, 2010·Journal of Thoracic Oncology : Official Publication of the International Association for the Study of Lung Cancer·Katsuyuki HottaMitsune Tanimoto
Apr 16, 2011·Cancer·Judith E NelsonJuan P Wisnivesky
Aug 16, 2011·Health Expectations : an International Journal of Public Participation in Health Care and Health Policy·David B PortnoySteven B Clauser
Nov 4, 2011·Journal of Pain and Symptom Management·Koen PardonUNKNOWN End-of-Life Information and Communication Consortium
May 5, 2012·Journal of the American College of Radiology : JACR·Mark MasciocchiBenjamin Lloyd
Jun 14, 2012·JAMA : the Journal of the American Medical Association·Rebecca Smith-BindmanAndrew E Williams
Jul 4, 2012·Journal of the American College of Radiology : JACR·Ronilda LacsonUNKNOWN Fleischner Society
Dec 21, 2012·Health Expectations : an International Journal of Public Participation in Health Care and Health Policy·Renda Soylemez WienerJack A Clark
Mar 2, 2013·The Journal of Ambulatory Care Management·Stephen M Davidson
Aug 21, 2013·Annals of the American Thoracic Society·Christopher G SlatoreLinda Ganzini
Jul 19, 2014·Patient Education and Counseling·France Légaré, Philippe Thompson-Leduc

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Citations

Mar 11, 2016·Journal of Thoracic Oncology : Official Publication of the International Association for the Study of Lung Cancer·Marc R FreimanRenda Soylemez Wiener
May 6, 2016·Annals of the American Thoracic Society·Erika M MosesonChristopher G Slatore
Jan 24, 2017·Patient Education and Counseling·Megan CoylewrightStuart W Grande
Apr 25, 2017·Journal of the American College of Radiology : JACR·Jonathan ShelverKathryn Rice
Mar 10, 2017·Annals of the American Thoracic Society·Jonathan M IaccarinoRenda Soylemez Wiener
Nov 16, 2017·AJR. American Journal of Roentgenology·Stella K KangAngela Fagerlin
May 26, 2021·The Annals of Thoracic Surgery·Zachary SmithRenee L Manser
Dec 22, 2019·Chest·Francys C VerdialFarhood Farjah

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