Challenges and current practices in the management of pulmonary nodules in China: a mixed methods study

Pulmonary nodules (PNs) are often asymptomatic but have the potential to become early lung cancer. Although guidelines emphasize the need for structured follow-up, adherence to recommendations remains low in China. Management programs in several countries have successfully improved follow-up adherence; however, such initiatives are lacking in China. Information regarding the barriers and challenges in PNs management in China, as well as patient and physician needs, are limited in China. This study investigated the follow-up practices, identified the obstacles, and evaluated the feasibility of management programs in China through surveys and interviews, aiming to inform future patient service initiatives and address existing deficiencies.

A mixed methods explanatory sequential study was conducted to investigate the management of PNs in China. Phase one involved a quantitative survey of 500 patients with PN, and logistic regression was used to identify factors influencing adherence. Phase two employed semistructured interviews with 10 physicians to clarify the barriers and strategies for PN management programs. Data were analyzed using a conventional content analysis approach, which generated themes on current management adherence, obstacles to large management programs, and future trends.

In phase one, analysis of 457 valid surveys revealed that higher anxiety levels were associated with poor adherence to follow-up recommendations [adjusted odds ratio (OR) =0.49; P=0.002] and that larger nodule size (adjusted OR =1.24; P=0.03) was associated with greater adherence to follow-up recommendations. Smoking history was linked to lower follow-up intention in the univariate model (Crude OR =0.47; P=0.048) but not in the multivariable model. Only two patients had participated in PN management programs, with 64.11% being unaware of such programs. In phase two, the interviews with 10 physicians indicated large discrepancies between guidelines and practice in PN management and a lack of structured PN management programs in China. Challenges included variability in standards, difficulty sharing computed tomography (CT) imaging, and limited institutional support.

This mixed methods study highlights the substantial deficiencies and challenges in PN management in China. Key factors influencing adherence include nodule size, patient anxiety, and smoking history. The lack of uniform management guidelines and difficulties in sharing CT imaging data constitute the major obstacles to implementing a large-scale PN management program. The findings emphasize the need for standardized management guidelines, comprehensive patient education, and improved CT imaging data sharing systems in China.