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PCPs lack resources to consult with patients on pulmonary nodules

Primary care providers tend to lack the resources to improve patient-centered approaches when discussing incidental pulmonary nodules with patients, according to study results.

“While PCPs want, and try, to provide high quality care, they often lack systemic resources that would allow them to effectively do so,” Sara E. Golden, MPH, of the VA Portland Health Care System in Oregon, told Healio.com/Pulmonology. “PCPs feel like they do not have adequate tracking methods to ensure follow-up, and may not have the appropriate information to give the patient.”

Sara E. Golden

The researchers conducted a qualitative study and interviewed 12 PCPs at the VA Portland Health Care System and three PCPs at the Boston University Medical Center to gauge clinicians’ information exchange and communications behaviors regarding lung nodules. Many of the PCPs reported inadequate knowledge and were concerned with providing misinformation to patients. Most did not use “risk calculators” in predicting lung cancer risk but rather obtained follow-up imaging based on a radiologist’s recommendations.

PCPs always selected the duration of a follow-up based on the radiologist’s recommendations. Many of the clinicians also reported contacting either a radiologist or pulmonologist to assist in determining appropriate follow-up if recommendations were unclear or if they had other questions.

Clinicians also reported not actively involving a patient in decision-making unless the patient expressed concern over the plan set by the clinician for surveillance imaging.

The researchers identified a need for PCPs and pulmonologists to combine forces to improve PCPs’ knowledge on pulmonary nodules as well as the patient experience. They also found discussions between PCPs and pulmonologists would help PCPs in conversing with patients on the risk for cancer.

“Pulmonologists are often consulted regarding follow-up strategies, but they can also aid their primary care colleagues by providing accurate information to counsel patients, and assisting in managing conversations about the risk of cancer,” Golden said. “Systemic changes that include comprehensive strategies to improve PCPs’ and patients’ knowledge about pulmonary nodules, better identify patients who experience distress and incorporate strategies to mitigate that distress, and enable tracking of follow-up imaging will be necessary for successful lung cancer screening implementation.” –by Ryan McDonald

Disclosure: The researchers report no relevant financial disclosures.