Improving decisions about evaluating pulmonary nodules for lung cancer

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DESCRIPTION (provided by applicant): CANDIDATE - I am a pulmonologist and health outcomes researcher with a focus on lung cancer control and prevention. While I have already received my MD and MPH degrees, completed a fellowship in outcomes research, and have received funding as a Co-PI on a VA HSR&D grant to study resource utilization in evaluation of potentially cancerous pulmonary nodules, I will require further training and dedicated mentorship to achieve my career goal of becoming a leading investigator in lung cancer control. INSTITUTION - The Dartmouth Institute for Health Policy and Clinical Practice, Center for Shared Decision- Making, Norris Cotton Cancer Center, and VA Outcomes Group offer the resources to succeed in my research. PROJECT BACKGROUND - With rising use of CT scans, physicians are faced with an increasingly common diagnostic challenge - the incidental pulmonary nodule. The fear is that the nodule may be cancer. In reality, very few turn out to be malignant, but identifying this subset is difficult and involves significant trade-offs. There are no randomized trials comparing management strategies (e.g., biopsy, radiologic surveillance, no further work-up) and no literature characterizing the impact of pulmonary nodules on patients and doctors. PROJECT OBJECTIVES - To systematically study the impact on patients and physicians of diagnosing pulmonary nodules, and to use this information to develop and test a decision aid to improve knowledge about nodules and promote shared decision-making. The project has 3 specific aims: Aim I: Characterize patients' understanding of and experience with pulmonary nodules. To determine patients' beliefs about pulmonary nodules (including lung cancer risk perception) and experience (including anxiety) with management strategies, I will develop, validate, and conduct a large-scale patient survey. -Aim II: Characterize physicians' beliefs about and management of pulmonary nodules. To learn how physicians manage, discuss, and think about pulmonary nodules (including risk of lung cancer), I will develop and conduct a nationally representative survey of primary care and pulmonary physicians. -Aim III: Develop a decision aid to improve clinical care and to use in a future randomized trial. Synthesizing the findings of Aims I and II with the evidence on pulmonary nodule natural history and management, I will create and test a decision aid for patients with pulmonary nodules. I will use the decision aid to achieve informed consent in a subsequent randomized comparative effectiveness trial of management strategies. CAREER GOALS - To become a leading independent investigator in cancer control and prevention, focusing on pulmonary nodules and lung cancer outcomes. My mentorship team includes experts in survey research, risk communication, medical decision-making, radiology, pulmonology, and oncology to help me achieve my project goals and guide me in my career development. Courses in psychometrics, decision-making, statistics, cancer control, and grant-writing will provide me with key skills for this project and my career. PUBLIC HEALTH RELEVANCE: Pulmonary nodules create a huge burden on the healthcare system, and patients and physicians may have significant misconceptions about their natural history and management. Research on patient and physician views on pulmonary nodules, as well as tools to promote shared decision-making around nodule management should be a priority to improve knowledge, quality of life, and care of these patients.