title: Primary Care Providers and a System Problem: A Qualitative Study of Clinicians Caring for Patients With Incidental Pulmonary Nodules.
abstract: BACKGROUND
  As lung cancer screening with low-dose CT scanning is implemented, an increasing number of people will be diagnosed with pulmonary nodules. Primary care clinicians care for the vast majority of these patients, but their experiences with communication and managing distress in this population are not well understood.
  
  
  METHODS
  We conducted qualitative interviews of 15 primary care providers (PCPs) at two academic medical centers who care for patients with pulmonary nodules. We used qualitative description analysis, focusing on clinicians' information exchange and other communication behaviors.
  
  
  RESULTS
  Most PCPs believed they had inadequate information to counsel patients regarding lung nodules, although this information is desired. PCPs were concerned patients could "fall through the cracks" but did not have access to a reliable system to ensure follow-up adherence. They were limited by time, knowledge, and resources in providing the preferred level of care. Most PCPs did not discuss the specific risk a nodule was lung cancer, in part because they did not have ready access to this information. PCPs believed most patients did not have substantial distress as a result of nodule detection. Most PCPs did not include patients when making decisions about the follow-up plan.
  
  
  CONCLUSIONS
  PCPs often lack systemic resources to optimize patient-centered approaches when discussing incidental pulmonary nodules with patients. With the advent of lung cancer screening, pulmonologists can assist primary care colleagues by providing accurate information to counsel patients and assisting in managing conversations about the risk of cancer. Pulmonologists should support efforts to implement reliable systems to ensure adherence to follow-up.
authors: From the Health Services Research and Development, Department of Medicine, Oregon Health and Science University, Portland, OR. Electronic address: sara.golden1@va.gov.
authors: Sara E
authors: SE
authors: Golden
authors: Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA; The Pulmonary Center, Boston University School of Medicine, Boston, MA.
authors: Renda Soylemez
authors: RS
authors: Wiener
authors: From the Health Services Research and Development, Department of Medicine, Oregon Health and Science University, Portland, OR; Division of Geriatric Medicine, Department of Psychiatry, Department of Medicine, Oregon Health and Science University, Portland, OR.
authors: Donald
authors: D
authors: Sullivan
authors: From the Health Services Research and Development, Department of Medicine, Oregon Health and Science University, Portland, OR; Division of Geriatric Medicine, Department of Psychiatry, Department of Medicine, Oregon Health and Science University, Portland, OR.
authors: Linda
authors: L
authors: Ganzini
authors: From the Health Services Research and Development, Department of Medicine, Oregon Health and Science University, Portland, OR; Section of Pulmonary and Critical Care Medicine, VA Portland Health Care System, Portland, OR; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, OR.
authors: Christopher G
authors: CG
authors: Slatore
mesh_terms: D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making; D003144:Communication Barriers; D006801:Humans; D033162:Incidental Findings; D008175:Lung Neoplasms / Q000175:diagnosis / Q000523:psychology; D055613:Multiple Pulmonary Nodules / Q000175:diagnosis / Q000523:psychology; D020380:Needs Assessment; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care / Q000523:psychology / Q000592:standards; D036301:Qualitative Research; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis / Q000523:psychology