Study Emphasizes Importance of Provider Communication in Easing Patient Anxiety

How do patients react to the incidental detection of pulmonary nodules? Does associated distress impact their perceived risk of lung cancer? These were some of the questions asked by physicians who surveyed patients at the Boston Medical Center, Dartmouth-Hitchcock Medical Center, and the Boston VA Healthcare system.

The US Preventive Services Task Force (USPSTF) finalized a “B” recommendation for annual lung cancer screenings with low-dose computed tomography (LDCT) for adults ages 55 to 80 years who had smoked 30 pack per year. USPSTF’s recommendation was based on results of the National Lung Screening Trial, which reported that 3 annual LDCT screens, compared with standard lung X-rays, reduced lung cancer mortality by 20% and overall mortality by 7%.

In their paper published in the Journal of Thoracic Oncology, researchers report their interest in evaluating the psychological distress associated with the detection of these pulmonary nodules. To better understand patients’ knowledge, beliefs, and distress associated with detection and evaluation of a pulmonary nodule, as well as their impressions of clinician communication, the authors dispensed a cross-sectional survey to 490 adults with an incidental pulmonary nodule, recruited from one of the above-mentioned care sites. Among the 50% (244) individuals who responded to the survey, the average nodule size was 7 mm and mean patient age was 67 years. About 70% of respondents were male.

The authors found that 26% of respondents reported clinically significant distress related to their nodule, with a majority of concerns with uncertainty about the nodule’s cause (78%), the possibility of cancer (73%), and the possible need for surgery (64%). Only 25% of patients accurately estimated their lung cancer risk, the authors write, and overall they found no correlation between perceived and actual risk (r = —0.007, P = .93). Further, most of the patients who were informed about their cancer risk by the provider, found the information reassuring (16%) than scary (7%).

Based on their survey results, the authors conclude that clinician communication can help bridge knowledge gaps in some patients. “This survey again highlights the psychological toll that uncertainty can cause, and the importance of supporting patients through the potentially distressing period of nodule surveillance,” they write. “Addressing these concerns has potential to improve both psychological and physical health outcomes, as high levels of cancer-related distress in other contexts have been associated with poor adherence with screening, evaluation, and treatment.”

Reference

Freiman MR, Clark JA, Slatore CG, et al. Patients’ knowledge, beliefs, and distress associated with detection and evaluation of incidental pulmonary nodules for cancer: results from a multicenter survey. J Thorac Oncol. 2016. doi: http://dx.doi.org/10.1016/j.jtho.2016.01.018.