Strategies for the management of solitary pulmonary nodules : A survey of patient preferences

Journal article


Smith, Zachary, Barnett, Stephen A., Gorelik, Alexandra, Pascoe, Diane M. and Manser, Renee L.. (2021). Strategies for the management of solitary pulmonary nodules : A survey of patient preferences. The Annals of Thoracic Surgery. 113(5), pp. 1670-1675. https://doi.org/10.1016/j.athoracsur.2021.04.094
AuthorsSmith, Zachary, Barnett, Stephen A., Gorelik, Alexandra, Pascoe, Diane M. and Manser, Renee L.
Abstract

Background
Guideline-based strategies for evaluation of solitary pulmonary nodules are tailored to the likelihood of malignancy. Surveillance, biopsy, and resection are all reasonable approaches in fit individuals when the likelihood of malignancy is intermediate. Given the paucity of data demonstrating superior outcomes and important trade-offs among strategies, guidelines emphasize the importance of eliciting patient preferences and engaging in shared decision making; however, there is little literature on what patient preferences actually are.

Methods
This study conducted a cross-sectional, interview-administered questionnaire survey in 100 adults recruited from a metropolitan teaching hospital (The Royal Melbourne Hospital, Parkville, Victoria, Australia). The questionnaire used a hypothetical scenario designed to elicit patient preferences for different management strategies of solitary pulmonary nodules with a probability of malignancy between 10% and 70%.

Results
The mean age of participants was 62 years (range, 45 to 80 years), 56% were male, and 94% were current smokers or ex-smokers. Ninety-four percent completed all questions. At 10% probability of malignancy, 36.3% preferred surveillance, 42.4% preferred needle biopsy, and 21.2% preferred surgical resection. Preference for surgical resection increased to 53.5% and 86.2% when the probability of malignancy was 30% and 70%, respectively. Changes in the diagnostic yield of computed tomography biopsy significantly altered preferences when the probability of malignancy was 10% or 30%.

Conclusions
The majority of participants surveyed expressed a preference for some type of biopsy over observation at all levels of solitary pulmonary nodule probability of malignancy evaluated. In an era of increasing solitary pulmonary nodule detection and patient-centered care, if confirmed in broader studies, these findings have considerable implications for processes of care and resource allocation.

Year2021
JournalThe Annals of Thoracic Surgery
Journal citation113 (5), pp. 1670-1675
PublisherElsevier Inc.
ISSN0003-4975
Digital Object Identifier (DOI)https://doi.org/10.1016/j.athoracsur.2021.04.094
Scopus EID2-s2.0-85118244738
Page range1670-1675
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online23 May 2021
Publication process dates
Accepted23 Apr 2021
Deposited21 Nov 2022
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