Patient vs Clinician Perspectives on Communication About Results of Lung Cancer Screening A Qualitative Study
Patient vs Clinician Perspectives on Communication About Results of Lung Cancer Screening A Qualitative Study
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DOI：
10.1016/j.chest.2020.03.081
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发表时间：
2020-09-01
期刊：
影响因子：
9.6
通讯作者：
Kathuria, Hasmeena
中科院分区：
文献类型：
--
作者：
Wiener, Renda Soylemez;Clark, Jack A.;Kathuria, Hasmeena
背景：在偶发肺结节和乳腺癌筛查环境中，高质量的以患者为中心的沟通可以提高对评估的忠诚度，减轻患者的痛苦。虽然指南强调肺癌筛查前的共同决策，但对肺癌筛查后患者与临床医生的沟通知之甚少。研究问题：患者和临床医生如何看待肺癌筛查后的沟通和结果通知，是否有可能缓解或加剧痛苦的方法？研究设计和方法：我们对前一年接受肺癌筛查的49名患者和36名传达筛查结果的临床医生(初级保健提供者、肺科医生、护士)进行了访谈和焦点小组，这些医生来自4家医院的肺癌筛查项目。结果：临床医生和患者对肺癌筛查后沟通质量的印象不同。临床医生认识到患者痛苦的可能性，并根据他们感知的结果的临床相关程度定制他们的披露方法。正常或低风险发现的披露通常通过信件进行；临床医生认为这一过程是有效的，并受到患者的欢迎。然而，许多患者并不满意：一些人根本不记得收到过结果，还有一些人报告说，通过信件收到结果让他们感到困惑和担忧，几乎没有机会提问。相比之下，结节较大的患者通常会在立即打电话或就诊时收到结果，患者和临床医生都认为这些对话代表着满足患者需求的高质量沟通。不管他们的癌症风险如何，在对话中得知结果的患者都很感激有机会讨论结节和评估计划的含义，并解决他们的担忧，先发制人。干预：在低风险病例中，临床医生对结果信函通知的效率感兴趣，与患者需要了解和安抚筛查结果、其影响以及后续筛查或结节评估的计划之间存在紧张--即使临床医生并不认为结果是相关的。讨论肺癌筛查结果的简短对话可能会提高患者的理解和满意度，同时减少痛苦。
BACKGROUND: In the incidental pulmonary nodule and breast cancer screening settings, high quality patient-centered communication can improve adherence to evaluation and mitigate patient distress. Although guidelines emphasize shared decision-making before lung cancer screening, little is known about patient-clinician communication after lung cancer screening.RESEARCH QUESTION: How do patients and clinicians perceive communication and results notification after lung cancer screening, and are there approaches that may mitigate or exacerbate distress?STUDY DESIGN AND METHODS: We conducted interviews and focus groups with 49 patients who underwent lung cancer screening in the prior year and 36 clinicians who communicate screening results (primary care providers, pulmonologists, nurses), recruited from lung cancer screening programs at 4 hospitals. We analyzed transcripts using conventional content analysis.RESULTS: Clinicians and patients diverged in their impressions of the quality of communication after lung cancer screening. Clinicians recognized the potential for patient distress and tailored their approach to disclosure based on how clinically concerning they perceived results to be. Disclosure of normal or low-risk findings usually occurred by letter; clinicians believed this process was efficient and well received by patients. Yet many patients were dissatisfied: several could not recall receiving results at all, and others reported that receiving results by letter left them confused and concerned, with little opportunity to ask questions. By contrast, patients with larger nodules typically received results during an immediate phone call or clinic visit, and both patients and clinicians agreed that these conversations represented high-quality communication that met patient needs. Regardless of their cancer risk, patients who learned their results in a conversation appreciated the opportunity to discuss both the meaning of the nodule and the evaluation plan, and to have their concerns addressed, preempting distress.INTERPRETATION: Tension exists between clinicians' interest in efficiency of results notification by letter in low-risk cases and patients' need to understand and be reassured about screening results, their implications, and the plan for subsequent screening or nodule evaluation-even when clinicians did not perceive results as concerning. Brief conversations to discuss lung cancer screening results may improve patient understanding and satisfaction while reducing distress.