Pulmonary Nodule Evaluation: Process and Feelings (CDA 10-025)
Christopher G. Slatore MD MS
Portland VA Medical Center, Portland, OR
Portland, OR
Funding Period: October 2011 - September 2014

BACKGROUND/RATIONALE:
Almost 75% of Veterans have a history of tobacco use and combined with the rapidly increasing use of computed tomography (CT), there is an increased number of patients with incidental findings, often pulmonary nodules, that are suspicious for lung cancer. Many of these findings will be falsely positive but due to the lethality of lung cancer, the difficulty of sampling small lesions, and predicted rates of tumor growth, it is currently recommended to follow these incidental findings for up to two years. The psychosocial risks of lung cancer evaluation are unknown but it is quite likely that lung cancer evaluation is stressful. The behavioral risks of evaluation are also not known, including how adherent patients are with the process or how it impacts their most important risk for lung cancer development, tobacco use. Patient-clinician communication is a fundamental process in clinical care and is central to the delivery of high quality care. Most of the factors involved in lung cancer evaluation are not modifiable so improving patient-clinician communication is one of the few methods to decrease the distress felt by patients.

OBJECTIVE(S):
Aim 1: Using qualitative methods, explore Veterans' and clinicians' understanding, experiences, and perceptions of the process of prolonged lung cancer evaluation.
Aim 2: Prospectively evaluate Veterans who are undergoing lung cancer evaluation by examining psychosocial outcomes (e.g. anxiety and emotional distress), behavior (tobacco use, adherence to the diagnostic strategy), and perceptions of the clinician's communication.

METHODS:
I will first perform a qualitative study used grounded theory and standard coding techniques amongst patients undergoing lung cancer evaluation. Next, I will perform a qualitative study of clinicians as well. Lastly, I will design a prospective, longitudinal cohort study of patients undergoing lung cancer evaluation. For this step, I will utilize a survey, based on conceptual models and previous research, to adequately measure patients' feelings about communication, their mental health and quality of life, and smoking habits.

FINDINGS/RESULTS:
None to date.

IMPACT:
The process of lung cancer evaluation is likely stressful and may be more so for Veterans given their high rate of concomitant mental illness. There are no data about either the risks of this process or methods to minimize these risks. This study will both measure the likely consequences of lung cancer evaluation and help identify modifiable factors in the patient-clinician relationship to help mitigate these effects. Thus, this study is highly relevant to VA's mission to provide the highest quality care to Veterans.


PUBLICATIONS:
None at this time.

DRA: Cancer, Lung Disorders, Aging, Older Veterans' Health and Care
DRE: Treatment - Observational
Keywords: Career Development
MeSH Terms: none