Christopher G Slatore1,2,3, Renda Soylemez Wiener4,5, Sara E Golden1, David H Au6,7, Linda Ganzini1,8. 1. 1 Center to Improve Veteran Involvement in Care and. 2. 2 Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, Portland, Oregon. 3. 3 Division of Pulmonary & Critical Care Medicine, Department of Medicine, and. 4. 4 Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, Massachusetts. 5. 5 The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts. 6. 6 Health Service Research and Development, VA Puget Sound Health Care System, Seattle, Washington; and. 7. 7 Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, Washington. 8. 8 Department of Psychiatry, Oregon Health & Science University, Portland, Oregon.
Abstract
RATIONALE: Millions of patients are diagnosed with pulmonary nodules every year. Increased distress may be a common harm, but methods of mitigating this distress are unclear. OBJECTIVES: We aimed to determine whether high-quality communication regarding the discovery of a pulmonary nodule is associated with a lower level of patient distress. METHODS: We conducted a prospective, repeated-measures cohort study of 121 patients with newly reported, incidentally detected pulmonary nodules. The primary exposure was participant-reported quality of communication regarding the nodule. Secondary exposures included communication measures regarding participants' values, preferences, and decision making. The main outcome was nodule-related distress measured using the Impact of Event Scale. We used adjusted generalized estimating equations to measure the association between nodule communication quality and at least mild distress. MEASUREMENTS AND MAIN RESULTS: Most participants (57%) reported at least mild distress at least once. While average distress scores decreased over time, one-fourth still had elevated distress after 2 years of surveillance for a nodule. The average calculated risk of cancer at baseline was 10% (SD, 13%), but 52.4% believed they had a greater than 30% risk of lung cancer at baseline, and this percentage remained fairly constant at all visits. High-quality nodule communication was associated with decreased odds of distress (adjusted odds ratio, 0.42; 95% confidence interval, 0.24-0.73). Lower-quality communication processes regarding participants' values and preferences were also associated with increased odds of distress, but concordance between the actual and preferred decision-making roles was not. CONCLUSIONS: Among patients with incidentally discovered pulmonary nodules, distress is common and persistent for about 25%. Many participants substantially overestimate their risk of lung cancer. Incorporating patients' values and preferences into communication about a pulmonary nodule and its evaluation may mitigate distress.
RATIONALE: Millions of patients are diagnosed with pulmonary nodules every year. Increased distress may be a common harm, but methods of mitigating this distress are unclear. OBJECTIVES: We aimed to determine whether high-quality communication regarding the discovery of a pulmonary nodule is associated with a lower level of patient distress. METHODS: We conducted a prospective, repeated-measures cohort study of 121 patients with newly reported, incidentally detected pulmonary nodules. The primary exposure was participant-reported quality of communication regarding the nodule. Secondary exposures included communication measures regarding participants' values, preferences, and decision making. The main outcome was nodule-related distress measured using the Impact of Event Scale. We used adjusted generalized estimating equations to measure the association between nodule communication quality and at least mild distress. MEASUREMENTS AND MAIN RESULTS: Most participants (57%) reported at least mild distress at least once. While average distress scores decreased over time, one-fourth still had elevated distress after 2 years of surveillance for a nodule. The average calculated risk of cancer at baseline was 10% (SD, 13%), but 52.4% believed they had a greater than 30% risk of lung cancer at baseline, and this percentage remained fairly constant at all visits. High-quality nodule communication was associated with decreased odds of distress (adjusted odds ratio, 0.42; 95% confidence interval, 0.24-0.73). Lower-quality communication processes regarding participants' values and preferences were also associated with increased odds of distress, but concordance between the actual and preferred decision-making roles was not. CONCLUSIONS: Among patients with incidentally discovered pulmonary nodules, distress is common and persistent for about 25%. Many participants substantially overestimate their risk of lung cancer. Incorporating patients' values and preferences into communication about a pulmonary nodule and its evaluation may mitigate distress.
Entities:
Keywords:
health communication; lung cancer; pulmonary nodule
Authors: Renda Soylemez Wiener; Jack A Clark; Elisa Koppelman; Rendelle Bolton; Gemmae M Fix; Christopher G Slatore; Hasmeena Kathuria Journal: Chest Date: 2020-05-07 Impact factor: 9.410
Authors: Renda Soylemez Wiener; Elisa Koppelman; Rendelle Bolton; Karen E Lasser; Belinda Borrelli; David H Au; Christopher G Slatore; Jack A Clark; Hasmeena Kathuria Journal: J Gen Intern Med Date: 2018-02-21 Impact factor: 5.128
Authors: Donald R Sullivan; Sara E Golden; Linda Ganzini; Renda Soylemez Wiener; Karen B Eden; Christopher G Slatore Journal: Ann Am Thorac Soc Date: 2017-11
Authors: Shannon M Nugent; Sara E Golden; Donald R Sullivan; Charles R Thomas; Juan Wisnivesky; Somnath Saha; Christopher G Slatore Journal: Med Oncol Date: 2022-09-29 Impact factor: 3.738
Authors: Susan Fernandes; Gareth Williams; Elvira Williams; Katjana Ehrlich; James Stone; Neil Finlayson; Mark Bradley; Robert R Thomson; Ahsan R Akram; Kevin Dhaliwal Journal: Eur Respir J Date: 2021-03-25 Impact factor: 16.671