title: What the heck is a "nodule"? A qualitative study of veterans with pulmonary nodules.
abstract: BACKGROUND
  Every year, hundreds of thousands of patients are diagnosed with incidentally detected pulmonary nodules, and if lung cancer screening is widely implemented, thousands more will be identified. The psychosocial outcomes associated with incidental nodule detection in general practice settings are virtually unknown.
  
  
  OBJECTIVE
  The purpose of this study was to explore the experiences of patients with incidentally diagnosed pulmonary nodules.
  
  
  METHODS
  We conducted qualitative interviews of 19 veterans with incidentally detected pulmonary nodules. We used qualitative description for the analysis, focusing on patients' information exchange and other communication behaviors with their clinicians.
  
  
  RESULTS
  The patients were cared for by primary care clinicians and had small nodules that were unlikely to be malignant. Patients did not understand the term "nodule" although they knew it was related to cancer. They also did not understand the follow-up plan and most were unable to obtain better information from their clinician or other sources. Most patients experienced nodule-related distress that was usually mild, although sometimes severe. This distress was sometimes mitigated by patients' confidence in their clinician. Most patients wanted more and better information about their nodule.
  
  
  CONCLUSIONS
  Veterans from one hospital have little understanding of what nodules are, the likelihood of malignancy, and the follow-up plan. Their reaction to this knowledge deficit is variable and is likely related to preferred communication behaviors with their clinician. Evaluating communication in other settings is important to confirm these findings and to refine mechanisms to improve patient-centered care for those with incidentally detected pulmonary nodules.
authors: Health Services Research and Development, Portland Veterans Affairs Medical Center, Portland, OR, USA. christopher.slatore@va.gov
authors: Christopher G
authors: CG
authors: Slatore
authors: Nancy
authors: N
authors: Press
authors: David H
authors: DH
authors: Au
authors: J Randall
authors: JR
authors: Curtis
authors: Renda Soylemez
authors: RS
authors: Wiener
authors: Linda
authors: L
authors: Ganzini
mesh_terms: D000368:Aged; D003142:Communication; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033162:Incidental Findings; D008175:Lung Neoplasms / Q000175:diagnosis / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D036301:Qualitative Research; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis / Q000523:psychology*; D014728:Veterans / Q000523:psychology*
references: J Thorac Cardiovasc Surg. 2012 Jul;144(1):33-8
references: 22710039
references: Am J Med Genet A. 2009 Feb 15;149A(4):819-30
references: 19291763
references: J Gen Intern Med. 2009 Feb;24(2):252-5
references: 19089501
references: Med Decis Making. 2008 Nov-Dec;28(6):917-25
references: 18725404
references: Qual Health Res. 2003 Sep;13(7):905-23
references: 14502957
references: Soc Sci Med. 2000 Oct;51(7):1087-110
references: 11005395
references: Cancer. 2008 Jul 15;113(2):396-404
references: 18484588
references: Ann Intern Med. 2012 Oct 16;157(8):574-6
references: 22928172
references: Am J Geriatr Psychiatry. 2006 Nov;14(11):900-10
references: 17068312
references: J Am Coll Radiol. 2011 Oct;8(10):706-9
references: 21962785
references: N Engl J Med. 2011 Aug 4;365(5):395-409
references: 21714641
references: N Engl J Med. 2003 Jun 19;348(25):2535-42
references: 12815140
references: JAMA. 2012 Jun 13;307(22):2418-29
references: 22610500
references: J Health Commun. 2014;19(8):907-21
references: 24558957
references: Br J Cancer. 2010 Jan 5;102(1):27-34
references: 19935789
references: J Natl Cancer Inst. 2010 Dec 1;102(23):1771-9
references: 21119104
references: J Am Coll Radiol. 2012 Apr;9(4):245-50
references: 22469374
references: Patient Educ Couns. 2009 Mar;74(3):295-301
references: 19150199
references: Cochrane Database Syst Rev. 2011 Oct 05;(10):CD001431
references: 21975733
references: Arch Intern Med. 1997 Apr 28;157(8):849-55
references: 9129544
references: Chest. 2010 Sep;138(3):628-34
references: 20299633
references: Ann Behav Med. 2010 Feb;39(1):91-7
references: 20333563
references: Chest. 2004 May;125(5):1753-60
references: 15136387
references: JAMA. 2012 Jun 13;307(22):2400-9
references: 22692172
references: BMC Public Health. 2010 Oct 26;10:647
references: 20977751
references: Chest. 2013 Mar;143(3):672-677
references: 22814873
references: Eur Respir J. 2011 Jul;38(1):154-61
references: 21148229