Decision making among Veterans with incidental pulmonary nodules: A qualitative analysis - 05/02/15

Doi : 10.1016/j.rmed.2015.01.007

Christopher G. Slatore ^a,^b,^c,^⁎ , David H. Au ^d,^e, Nancy Press ^f, Renda Soylemez Wiener ^g,^h, Sara E. Golden ^a, Linda Ganzini ^a
^a Health Services Research & Development, Portland VA Medical Center, Portland, OR, USA
^b Section of Pulmonary & Critical Care Medicine, Portland VA Medical Center, Portland, OR, USA
^c Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
^d Health Service Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA
^e Division of Pulmonary & Critical Care Medicine, University of Washington School of Medicine, Seattle, WA, USA
^f School of Nursing, Oregon Health and Science University, Portland, OR, USA
^g Center for Health Quality, Outcomes, & Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, USA
^h The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA

^∗Corresponding author. 3710 SW US Veterans Hospital Rd. R&D 66, Portland, OR 97239, USA. Tel.: +1 503 220 8262 (office); fax: +1 503 273 5367.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 05 February 2015

Summary

Purpose

Among patients undergoing lung cancer evaluation for newly diagnosed, incidental pulmonary nodules, it is important to evaluate the shared power and responsibility domain of patient-centered communication. We explored Veterans' perceptions of decision making with regards to an incidentally-detected pulmonary nodule.

Methods

We conducted semi-structured, qualitative interviews of 19 Veterans from one medical center with incidentally-detected pulmonary nodules that were judged as having a low risk for malignancy. We used qualitative description for the analysis, focusing on patients' perceptions of shared decision making with their primary care provider (PCP). Interviews were conducted in 2011 and 2012.

Results

Patients almost always played a passive role in deciding how and when to evaluate their pulmonary nodule for the possibility of malignancy. Some patients felt comfortable with this role, expressing trust that their clinician would provide the appropriate care. Other patients were not satisfied with how these decisions were made with some expressing concern that no decisions had actually occurred. Regardless of how satisfied they were with the decision, patients did not report discussing how they liked to make decisions with their PCP.

Conclusions

Veterans in our study did not engage in shared decision making with their clinician. Some were satisfied with this approach although many would have preferred a shared approach. In order to reduce patient distress and improve satisfaction, clinicians may want to consider adopting a shared approach when making decisions about pulmonary nodule evaluation.

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Keywords : Pulmonary nodule, Lung cancer, Shared decision making