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Systems-Level Resources for Pulmonary Nodule Evaluation in the United States: A National Survey

2016; American Thoracic Society; Volume: 193; Issue: 9 Linguagem: Inglês

10.1164/rccm.201511-2163le

1535-4970

James A. Simmons, Michael K. Gould, Jonathan M. Iaccarino, Christopher G. Slatore, Renda Soylemez Wiener,

Radiomics and Machine Learning in Medical Imaging

Each year, more than 1.5 million Americans are found to have a pulmonary nodule (1).As lung cancer screening becomes prevalent, still more nodules will be identified.Whether detected incidentally or through screening, guidelines recommend evaluating pulmonary nodules in a timely fashion to identify the subset that are malignant.Yet patients with pulmonary nodules often do not receive appropriate evaluation, seemingly "falling through the cracks" (2, 3).Systems-level structures and processes of care have been proposed to facilitate appropriate, efficient nodule evaluation (4-8), and indeed, clinicians have indicated that such system-level resources are essential to avoid loss to follow-up (9).However, the degree to which these structures and processes of care have been implemented nationally is unclear, and the American Thoracic Society (ATS) has called for more research in this area (10).We conducted a survey of ATS clinicians to characterize the availability of system-level resources to facilitate pulmonary nodule evaluation in the United States. MethodsWe surveyed clinician members of the ATS Respiratory Cell and Molecular Biology and Clinical Problems Assemblies (the parent assemblies of the Section of Thoracic Oncology at the time of survey administration).Eligible clinicians included physicians or midlevel providers who regularly saw patients in an outpatient clinic.ATS sent three e-mails in March and April 2014, inviting clinicians to participate in an anonymous online survey, with a $50 incentive for completion.The 32-item survey asked about demographics, practice setting, and practices regarding lung cancer screening and nodule evaluation.The Boston University Institutional Review Board approved this study.Although this was an international survey, we restricted analysis to responses from U.S. clinicians, given differences in resource availability and practice patterns across countries.Proportions were compared using chi-squared tests, and medians with the Kruskal-Wallis test, with two-sided a , 0.05 as the threshold for statistical significance.All data were analyzed using Stata 10.1 (College Station, TX).