Multidisciplinary Team-Based Management of Incidentally Detected Lung Nodules
| Autor: | Sudhakar Pipavath, Megan E. Zadworny, Francys C. Verdial, Guang-Shing Cheng, Farhood Farjah, David K. Madtes, Richard Kim, Jesse J. Hubbard, Douglas E. Wood |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Pediatrics medicine.medical_specialty Lung Neoplasms Critical Care and Intensive Care Medicine Multidisciplinary team Risk Assessment Cohort Studies 03 medical and health sciences 0302 clinical medicine Multidisciplinary approach Early Medical Intervention medicine Humans In patient 030212 general & internal medicine Medical diagnosis Lung cancer Early Detection of Cancer Original Research Patient Care Team Health Services Needs and Demand Incidental Findings Lung business.industry Solitary Pulmonary Nodule Nodule (medicine) Middle Aged medicine.disease United States medicine.anatomical_structure 030228 respiratory system Practice Guidelines as Topic Female Guideline Adherence medicine.symptom Cardiology and Cardiovascular Medicine business Cohort study |
| Zdroj: | Chest |
| ISSN: | 0012-3692 |
| DOI: | 10.1016/j.chest.2019.11.032 |
| Popis: | Background Each year, > 1.5 million Americans are diagnosed with an incidentally detected lung nodule. Practice guidelines attempt to balance the benefit of early detection of lung cancer with the risks of diagnostic testing, but adherence to guidelines is low. The goal of this study was to determine guideline adherence rates in the setting of a multidisciplinary nodule clinic and describe reasons for nonadherence as well as associated outcomes. Methods This cohort study included 3 years of follow-up of patients aged ≥ 35 years with an incidentally detected lung nodule evaluated in a multidisciplinary clinic that used the 2005 Fleischner Society Guidelines. Results Among 113 patients, 67% (95% CI, 58-76) were recommended a guideline-concordant nodule evaluation; 7.1% (95% CI, 3.1-13) and 26% (95% CI, 18-25) were recommended less or more intense evaluation, respectively. In contrast, 58% (95% CI, 48-67), 22% (95% CI, 18-25), and 23% (95% CI, 16-32) received a guideline-concordant, less intense, or more intense evaluation. The most common reason for recommending guideline-discordant care was concern for two different diagnoses that would each benefit from early detection and treatment. A majority of lung cancer diagnoses (88%) occurred in patients who received guideline-concordant care. There were no lung cancer cases in those who received less intense nodule care. Conclusions A multidisciplinary nodule clinic may serve as a system-level intervention to promote guideline-concordant care, while also providing a multidisciplinary basis by which to deviate from guidelines to address the needs of a heterogeneous patient population. |
| Databáze: | OpenAIRE |
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