Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

VA Health Systems Research

Go to the VA ORD website
Go to the QUERI website

CDP 11-227 – HSR Study

CDP 11-227
Pulmonary Nodule Evaluation: Process and Feelings (CDA 09-025)
Christopher G. Slatore, MD MS
VA Portland Health Care System, Portland, OR
Portland, OR
Funding Period: October 2011 - September 2014
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.

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.

I will first perform a qualitative study using 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, quality of life, and smoking habits.

1. Patients with incidental pulmonary nodules often receive inadequate information about the causes of nodules, the individualized risk of lung cancer, and details about the follow-up plan.
2. Distress is common among these patients. Based on quantitative analyses, almost 50% of patients have at least mild distress. It is occasionally severe.
3. Patients often substantially overestimate the risk the nodule is lung cancer.
4. Satisfaction with the clinician's communication practices is associated with less distress. Satisfaction with knowledge about the nodule and lower self-perceived risk of lung cancer are not associated with distress.

The process of lung cancer evaluation appears to be stressful for many Veterans and may be more so for those Veterans who report lower quality patient-centered communication. There are no previous data among Veterans about either the risks of this process or the 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. 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

Dimensions for VA

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

Learn more about Dimensions for VA.

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.
    Search Dimensions for this project


None at this time.

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

Questions about the HSR website? Email the Web Team

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.