title: 'I still don't know diddly': a longitudinal qualitative study of patients' knowledge and distress while undergoing evaluation of incidental pulmonary nodules.
abstract: BACKGROUND
  Hundreds of thousands of incidental pulmonary nodules are detected annually in the United States, and this number will increase with the implementation of lung cancer screening. The lengthy period for active pulmonary nodule surveillance, often several years, is unique among cancer regimens. The psychosocial impact of longitudinal incidental nodule follow-up, however, has not been described.
  
  
  OBJECTIVE
  We sought to evaluate the psychosocial impact of longitudinal follow-up of incidental nodule detection on patients.
  
  
  METHODS
  Veterans who participated in our previous study had yearly follow-up qualitative interviews coinciding with repeat chest imaging. We used conventional content analysis to explore their knowledge of nodules and the follow-up plan, and their distress.
  
  
  RESULTS
  Seventeen and six veterans completed the year one and year two interviews, respectively. Over time, most patients continued to have inadequate knowledge of pulmonary nodules and the nodule follow-up plan. They desired and appreciated more information directly from their primary care provider, particularly about their lung cancer risk. Distress diminished over time for most patients, but it increased around the time of follow-up imaging for some, and a small number reported severe distress.
  
  
  CONCLUSIONS
  In settings in which pulmonary nodules are commonly detected, including lung cancer screening programmes, resources to optimise patient-centred communication strategies that improve patients' knowledge and reduce distress should be developed.
authors.affiliation: 1] Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, USA [2] Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Sullivan
authors.affiliation: Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, USA.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Golden
authors.affiliation: 1] Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, USA [2] Division of Geriatric Psychiatry, Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Ganzini
authors.affiliation: School of Nursing, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Lissi
authors.initials: L
authors.lastname: Hansen
authors.affiliation: 1] Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, USA [2] Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, OR, USA [3] Section of Pulmonary and Critical Care Medicine, Veterans Affairs Portland Health Care System, Portland, OR, USA.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Slatore
mesh_terms: D000368:Aged; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033162:Incidental Findings; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis*; D013315:Stress, Psychological / Q000523:psychology; D014728:Veterans