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 key for early lung cancer detection and avoiding unnecessary procedures.
• Knowledge gaps exist regarding clinician practices and improvement opportunities in PN evaluation.

Purpose of the Study:

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

Main Methods:

• Exploratory sequential mixed methods study involving qualitative interviews and a nationwide quantitative survey.
• 40 clinicians interviewed; 192 clinicians completed the online survey.
• Thematic analysis of interviews informed survey development and analysis.

Main Results:

• Most clinicians (70.8%) use risk assessment tools, primarily clinical risk prediction models (70.3%).
• A majority (63.5%) prioritize not missing lung cancer over avoiding procedures.
• Clinicians find PN evaluation challenging, requiring collaboration, but only 50.5% have adequate resources.

Conclusions:

• Clinicians perceive PN evaluation as challenging, necessitating multidisciplinary collaboration and shared decision-making.
• Inadequate resources hinder optimal PN care; system-level improvements in PN tracking and risk assessment are needed.