title: Distress and patient-centered communication among veterans with incidental (not screen-detected) pulmonary nodules. A cohort study.
abstract: BACKGROUND
  Incidental pulmonary nodule detection is postulated to cause distress, but the frequency and magnitude of that distress have not been reported. The quality of patient-clinician communication and the perceived risk of lung cancer may influence distress Objectives: To evaluate the association of communication processes with distress and the perceived risk of lung cancer using validated instruments.
  
  
  METHODS
  We conducted a prospective cohort study of patients with incidentally detected nodules who received care at one Department of Veterans Affairs Medical Center. We measured distress with the Impact of Event Scale and patient-centered communication with the Consultation Care Measure, both validated instruments. Risk of lung cancer was self-reported by participants. We used multivariable adjusted logistic regression to measure the association of communication quality with distress.
  
  
  RESULTS
  Among 122 Veterans with incidental nodules, 23%, 12%, and 4% reported experiencing mild, moderate, and severe distress, respectively, at the time they were informed of the pulmonary nodule. Participant-reported risk of lung cancer was not associated with distress. In the adjusted model, high-quality communication was associated with decreased distress (odds ratio [OR] = 0.28, 95% confidence interval [CI] = 0.08-1.00, P = 0.05). Among participants who reported a risk of malignancy of 30% or less, high-quality communication was associated with decreased distress (OR = 0.15, 95% CI = 0.02-0.92, P = 0.04), but was not associated with distress for those who reported a risk greater than 30% (OR = 0.12 (95% CI = 0.00-3.97, P = 0.24), although the P value for interaction was not significant.
  
  
  CONCLUSIONS
  Veterans with incidental pulmonary nodules frequently reported inadequate information exchange regarding their nodule. Many patients experience distress after they are informed that they have a pulmonary nodule, and high-quality patient-clinician communication is associated with decreased distress. Communication strategies that only target improved knowledge of the risk of malignancy may not be sufficient to reduce the distress associated with nodule detection.
authors.affiliation: 1 Health Services Research and Development, Portland Department of Veterans Affairs (VA) Medical Center, Portland, Oregon.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Slatore
authors.forename: Sara E
authors.initials: SE
authors.lastname: Golden
authors.forename: Linda
authors.initials: L
authors.lastname: Ganzini
authors.forename: Renda Soylemez
authors.initials: RS
authors.lastname: Wiener
authors.forename: David H
authors.initials: DH
authors.lastname: Au
mesh_terms: D000368:Aged; D001007:Anxiety / Q000523:psychology; D015331:Cohort Studies; D003142:Communication; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D033162:Incidental Findings; D057226:Information Seeking Behavior; D016015:Logistic Models; D008175:Lung Neoplasms / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D063868:Patient Outcome Assessment; D010465:Perception; D010817:Physician-Patient Relations; D011446:Prospective Studies; D012306:Risk; D012907:Smoking; D003074:Solitary Pulmonary Nodule / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*; D014342:Truth Disclosure; D014481:United States; D014728:Veterans / Q000523:psychology*
keywords: patient-centered outcomes; patient-clinician communication; pulmonary nodule