Communication About the Probability of Cancer in Indeterminate Pulmonary Nodules
| Autor: | Jonathan C. Nesbitt, Robert S. Dittus, Rhonda Pinkerman, Carol Callaway-Lane, Stephen A. Deppen, Eric S. Lambright, Pierre P. Massion, Eric L. Grogan, Amelia W. Maiga |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Lung Neoplasms Documentation Malignancy Risk Assessment Article Medical Records 03 medical and health sciences 0302 clinical medicine Risk Factors medicine Humans Veterans Affairs Aged Probability Retrospective Studies business.industry Communication Medical record Solitary Pulmonary Nodule Cancer Retrospective cohort study Middle Aged medicine.disease 030228 respiratory system Cardiothoracic surgery 030220 oncology & carcinogenesis Practice Guidelines as Topic Cohort Female Surgery Guideline Adherence Risk assessment business |
| Zdroj: | JAMA Surgery. 153:353 |
| ISSN: | 2168-6254 |
| DOI: | 10.1001/jamasurg.2017.4878 |
| Popis: | Importance Clinical guidelines recommend that clinicians estimate the probability of malignancy for patients with indeterminate pulmonary nodules (IPNs) larger than 8 mm. Adherence to these guidelines is unknown. Objectives To determine whether clinicians document the probability of malignancy in high-risk IPNs and to compare these quantitative or qualitative predictions with the validated Mayo Clinic Model. Design, Setting, and Participants Single-institution, retrospective cohort study of patients from a tertiary care Department of Veterans Affairs hospital from January 1, 2003, through December 31, 2015. Cohort 1 included 291 veterans undergoing surgical resection of known or suspected lung cancer from January 1, 2003, through December 31, 2015. Cohort 2 included a random sample of 239 veterans undergoing inpatient or outpatient pulmonary evaluation of IPNs at the hospital from January 1, 2003, through December 31, 2012. Exposures Clinician documentation of the quantitative or qualitative probability of malignancy. Main Outcomes and Measures Documentation from pulmonary and/or thoracic surgery clinicians as well as information from multidisciplinary tumor board presentations was reviewed. Any documented quantitative or qualitative predictions of malignancy were extracted and summarized using descriptive statistics. Clinicians’ predictions were compared with risk estimates from the Mayo Clinic Model. Results Of 291 patients in cohort 1, 282 (96.9%) were men; mean (SD) age was 64.6 (9.0) years. Of 239 patients in cohort 2, 233 (97.5%) were men; mean (SD) age was 65.5 (10.8) years. Cancer prevalence was 258 of 291 cases (88.7%) in cohort 1 and 110 of 225 patients with a definitive diagnosis (48.9%) in cohort 2. Only 13 patients (4.5%) in cohort 1 and 3 (1.3%) in cohort 2 had a documented quantitative prediction of malignancy prior to tissue diagnosis. Of the remaining patients, 217 of 278 (78.1%) in cohort 1 and 149 of 236 (63.1%) in cohort 2 had qualitative statements of cancer risk. In cohort 2, 23 of 79 patients (29.1%) without any documented malignancy risk statements had a final diagnosis of cancer. Qualitative risk statements were distributed among 32 broad categories. The most frequently used statements aligned well with Mayo Clinic Model predictions for cohort 1 compared with cohort 2. The median Mayo Clinic Model–predicted probability of cancer was 68.7% (range, 2.4%-100.0%). Qualitative risk statements roughly aligned with Mayo predictions. Conclusions and Relevance Clinicians rarely provide quantitative documentation of cancer probability for high-risk IPNs, even among patients drawn from a broad range of cancer probabilities. Qualitative statements of cancer risk in current practice are imprecise and highly variable. A standard scale that correlates with predicted cancer risk for IPNs should be used to communicate with patients and other clinicians. |
| Databáze: | OpenAIRE |
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