Perspectives on Managing Solitary Pulmonary Nodules: A Survey of Primary Care Physicians

Autor: Dan J. Raz, Can-Lan Sun, Kenny Yeung, Martin Consunji, Rebecca A. Nelson, Jae Y. Kim, Geena Wu
Rok vydání: 2017
Předmět:
Pulmonary and Respiratory Medicine
Subset Analysis
Adult
Male
medicine.medical_specialty
Health Knowledge
Attitudes
Practice
Lung Neoplasms
Referral
Attitude of Health Personnel
education
Primary care
Physicians
Primary Care
03 medical and health sciences
0302 clinical medicine
medicine
Odds Ratio
Humans
030212 general & internal medicine
Healthcare Disparities
Practice Patterns
Physicians'
Referral and Consultation
health care economics and organizations
Aged
Response rate (survey)
business.industry
Process Assessment
Health Care
Solitary Pulmonary Nodule
Pulmonologist
General Medicine
Odds ratio
Middle Aged
Confidence interval
Logistic Models
Treatment Outcome
030220 oncology & carcinogenesis
Family medicine
Health Care Surveys
Emergency medicine
Surgery
Female
Clinical Competence
Cardiology and Cardiovascular Medicine
business
Lung cancer screening
Specialization
Zdroj: Seminars in thoracic and cardiovascular surgery. 29(3)
ISSN: 1532-9488
Popis: Primary care physicians (PCPs) may be involved in the evaluation of solitary pulmonary nodules (SPNs) detected through lung cancer screening. Little is known about their perspectives on the management or the referral of SPN. Using the American Medical Association's Physician Masterfile, we randomly surveyed 1384 PCPs between January and October 2015 with an 18% response rate. A subset analysis was performed on SPN management and referral practices of PCP. These results and those relating to practice characteristics were compared between family practice and internal medicine physicians. Responders and nonresponders did not differ by demographic characteristics. A total of 137 (55.5%) PCPs reported feeling confident in managing the workup of imaging-detected SPN. However, only 53 PCPs (21.3%) were inclined to manage the evaluation and follow-up of SPN. There was no significant difference between family practice and internal medicine physicians with regard to years in practice, size of practice, or referral to specialists. Family practitioners and internists similarly disagreed or were neutral to self-managing SPN (P = 0.60). Internists were twice as likely to express confidence as family practitioners (odds ratio 1.95, 95% confidence interval 1.09-3.48). Among all PCPs, 75.4% would refer management of these patients to a pulmonologist, 28.9% to a surgeon, and 24.2% to an oncologist. Confidence did not predict lung cancer screening practices. Although more than half of PCPs expressed confidence in the workup of SPN, most preferred referral to specialists. Additional research is needed to understand barriers to PCP management of incidental SPN in the effort to facilitate lung cancer screening.
Databáze: OpenAIRE
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