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CDA 09-025 – HSR Study

 
CDA 09-025
Lung Cancer Evaluation Process: Understanding Risks Along the Continuum
Christopher G. Slatore, MD MS
VA Portland Health Care System, Portland, OR
Portland, OR
Funding Period: February 2011 - January 2015
BACKGROUND/RATIONALE:
Almost 75% of Veterans have a history of tobacco use, and combined with the rapidly increasing use of computed tomography (CT) and the advent of lung cancer screening, 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 and behavioral risks of lung cancer evaluation are unknown. Patient-clinician communication is fundamental in clinical care and is central to the delivery of high quality care. It is also one of the few modifiable 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 (e.g., tobacco use, adherence to the diagnostic strategy), and perceptions of the clinician's communication.

METHODS:
I will first perform a qualitative study using grounded theory and standard coding techniques amongst patients undergoing lung cancer evaluation and the clinicians who care for them. Next, I will conduct 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:
Not yet available.

IMPACT:
The process of lung cancer evaluation appears to be stressful for many Veterans and knowledge is lacking. There are no previous data among Veterans about either the risks of this process or methods to minimize these risks. This study measures both the likely consequences of lung cancer evaluation and helps 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. Furthermore, VA has begun a lung cancer screening demonstration project. My CDA was funded largely on the premise that screening would be implemented and substantially increase the number of patients identified with incidental pulmonary nodules. Now that this process has started, the results of this work will be relevant for an even larger number of Veterans.


External Links for this Project

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PUBLICATIONS:

None at this time.


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

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