title: Patient and Clinician Characteristics Associated with Adherence. A Cohort Study of Veterans with Incidental Pulmonary Nodules.
abstract: Many patients are diagnosed with small pulmonary nodules for which professional societies recommend subsequent imaging surveillance. Adherence to these guidelines involves many steps from both clinicians and patients but has not been well studied.
  
  
  
  In a health care setting with a nodule tracking system, we evaluated the association of communication processes and distress with patient and clinician adherence to recommended follow up and Fleischner Society guidelines, respectively.
  
  
  
  We conducted a prospective, longitudinally assessed, cohort study of patients with incidentally detected nodules who received care at one Veterans Affairs Medical Center. We measured patient-centered communication with the Consultation Care Measure and distress with the Impact of Event Scale. We abstracted data regarding participant adherence to clinician recommendations (defined as receiving the follow-up scan within 30 d of the recommended date) and clinician adherence to Fleischner guidelines (defined as planning the follow-up scan within 30 d of the recommended interval) from the electronic medical record. We measured associations of communication and distress with adherence using multivariable-adjusted generalized estimating equations.
  
  
  
  Among 138 veterans, 39% were nonadherent at least once during follow up. Clinicians were nonadherent to Fleischner guidelines for 27% of follow-up scans. High-quality communication (adjusted odds ratio, 3.65; P = 0.02) and distress (adjusted odds ratio, 0.38; P = 0.02) were associated with increased and decreased participant adherence, respectively. Neither was associated with clinician adherence.
  
  
  
  Patients and clinicians often do not adhere to nodule follow-up recommendations. Interventions designed to improve communication quality and decrease distress may also improve patient adherence to nodule follow-up recommendations.
authors.affiliation: 1 Pulmonary and Critical Care Medicine, Legacy Health, Portland, Portland, Oregon.|2 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: Erika M
authors.initials: EM
authors.lastname: Moseson
authors.affiliation: 3 Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, Massachusetts.|4 The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Renda Soylemez
authors.initials: RS
authors.lastname: Wiener
authors.affiliation: 5 Center to Improve Veteran Involvement in Care.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Golden
authors.affiliation: 6 Health Service Research and Development, VA Puget Sound Health Care System, Seattle, Washington; and.|7 Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, Washington.
authors.forename: David H
authors.initials: DH
authors.lastname: Au
authors.affiliation: 8 Department of Radiology, and.
authors.forename: John D
authors.initials: JD
authors.lastname: Gorman
authors.affiliation: 9 Section of Pulmonary and Critical Care Medicine, VA Portland Health Care System, Portland, Oregon.
authors.forename: Amber D
authors.initials: AD
authors.lastname: Laing
authors.affiliation: 2 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon.|9 Section of Pulmonary and Critical Care Medicine, VA Portland Health Care System, Portland, Oregon.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Deffebach
authors.affiliation: 2 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon.|5 Center to Improve Veteran Involvement in Care.|9 Section of Pulmonary and Critical Care Medicine, VA Portland Health Care System, Portland, Oregon.
authors.forename: Christopher G
authors.identifier: 0000-0003-0958-8122
authors.initials: CG
authors.lastname: Slatore
mesh_terms: D000368:Aged; D003142:Communication; D015897:Comorbidity; D057286:Electronic Health Records; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans; D006801:Humans; D033162:Incidental Findings; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000592:standards*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012959:Socioeconomic Factors; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014481:United States; D014728:Veterans
keywords: adherence; communication; pulmonary nodule