Contemporary Pulmonary Nodule Evaluation and Management in the U.S.: A Mixed Methods Study

Area of Science:

• Pulmonology
• Oncology
• Health Services Research

Background:

• Effective pulmonary nodule (PN) management is vital for early lung cancer detection and preventing unnecessary procedures.
• Gaps in understanding clinician practices and improvement opportunities for PN management persist.

Purpose of the Study:

• To identify factors influencing clinicians' pulmonary nodule (PN) evaluation and management.
• To determine perceived barriers to optimal clinical care for PNs.

Main Methods:

• An exploratory sequential mixed methods study involving qualitative interviews and a nationwide quantitative survey.
• 40 clinicians participated in semi-structured interviews, followed by a survey administered to 192 clinicians across various specialties.

Main Results:

• Most clinicians (70.8%) use risk assessment tools, primarily clinical risk prediction models (70.3%), for PN cancer risk evaluation.
• A majority (63.5%) prioritize not missing lung cancer diagnoses over avoiding invasive procedures.
• Clinicians perceive PN evaluation as challenging, emphasizing shared decision-making (95.8%) and multidisciplinary collaboration (91.1%), yet only 50.5% report adequate resources.

Conclusions:

• Clinicians face challenges in PN evaluation, requiring collaboration and shared decision-making, but often lack sufficient resources.
• System-level improvements in PN tracking and cancer risk assessment are recommended for optimal care.