Patient vs Clinician Perspectives on Communication About Results of Lung Cancer Screening: A Qualitative Study.

Autor:	Wiener RS; Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; The Pulmonary Center, Boston University School of Medicine, Boston, MA. Electronic address: rwiener@bu.edu., Clark JA; Boston University School of Public Health Boston, MA., Koppelman E; Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; Boston University School of Public Health Boston, MA., Bolton R; Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; Brandeis University Heller School for Social Policy and Management, Waltham, MA., Fix GM; Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; Boston University School of Public Health Boston, MA., Slatore CG; Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University, Portland, OR., Kathuria H; The Pulmonary Center, Boston University School of Medicine, Boston, MA.
Jazyk:	angličtina
Zdroj:	Chest [Chest] 2020 Sep; Vol. 158 (3), pp. 1240-1249. Date of Electronic Publication: 2020 May 07.
DOI:	10.1016/j.chest.2020.03.081
Abstrakt:	Background: In the incidental pulmonary nodule and breast cancer screening settings, high-quality patient-centered communication can improve adherence to evaluation and mitigate patient distress. Although guidelines emphasize shared decision-making before lung cancer screening, little is known about patient-clinician communication after lung cancer screening. Research Question: How do patients and clinicians perceive communication and results notification after lung cancer screening, and are there approaches that may mitigate or exacerbate distress? Study Design and Methods: We conducted interviews and focus groups with 49 patients who underwent lung cancer screening in the prior year and 36 clinicians who communicate screening results (primary care providers, pulmonologists, nurses), recruited from lung cancer screening programs at 4 hospitals. We analyzed transcripts using conventional content analysis. Results: Clinicians and patients diverged in their impressions of the quality of communication after lung cancer screening. Clinicians recognized the potential for patient distress and tailored their approach to disclosure based on how clinically concerning they perceived results to be. Disclosure of normal or low-risk findings usually occurred by letter; clinicians believed this process was efficient and well received by patients. Yet many patients were dissatisfied: several could not recall receiving results at all, and others reported that receiving results by letter left them confused and concerned, with little opportunity to ask questions. By contrast, patients with larger nodules typically received results during an immediate phone call or clinic visit, and both patients and clinicians agreed that these conversations represented high-quality communication that met patient needs. Regardless of their cancer risk, patients who learned their results in a conversation appreciated the opportunity to discuss both the meaning of the nodule and the evaluation plan, and to have their concerns addressed, preempting distress. Interpretation: Tension exists between clinicians' interest in efficiency of results notification by letter in low-risk cases and patients' need to understand and be reassured about screening results, their implications, and the plan for subsequent screening or nodule evaluation-even when clinicians did not perceive results as concerning. Brief conversations to discuss lung cancer screening results may improve patient understanding and satisfaction while reducing distress. (Published by Elsevier Inc.)
Databáze:	MEDLINE
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