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• W3022521788 abstract "BackgroundIn 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 QuestionHow 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 MethodsWe 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.ResultsClinicians 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.InterpretationTension 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. 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. How do patients and clinicians perceive communication and results notification after lung cancer screening, and are there approaches that may mitigate or exacerbate distress? 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. 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. 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. Guidelines recommend low-dose CT lung cancer screening (LCS) for older individuals with a heavy smoking history.1Mazzone P.J. Silvestri G.A. Patel S. et al.Screening for Lung Cancer: CHEST Guideline and Expert Panel Report.Chest. 2018; 153: 954-985Abstract Full Text Full Text PDF PubMed Scopus (137) Google Scholar, 2Wender R. Fontham E.T. Barrera Jr., E. et al.American Cancer Society lung cancer screening guidelines.CA Cancer J Clin. 2013; 63: 107-117Crossref PubMed Scopus (511) Google Scholar, 3Wood D.E. Kazerooni E. Baum S.L. et al.Lung cancer screening, version 1.2015: featured updates to the NCCN guidelines.J Natl Compr Canc Netw. 2015; 13: 23-34Crossref PubMed Scopus (84) Google Scholar, 4Jaklitsch M.T. Jacobson F.L. Austin J.H. et al.The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups.J Thorac Cardiovasc Surg. 2012; 144: 33-38Abstract Full Text Full Text PDF PubMed Scopus (436) Google Scholar, 5Moyer V.A. U.S. Preventive Services Task ForceScreening for lung cancer: U.S. Preventive Services Task Force recommendation statement.Ann Intern Med. 2014; 160: 330-338Crossref PubMed Google Scholar LCS commonly identifies pulmonary nodules that require evaluation—typically radiographic surveillance—to rule out malignancy.6Aberle D.R. Adams A.M. et al.National Lung Screening Trial Research TeamReduced lung-cancer mortality with low-dose computed tomographic screening.N Engl J Med. 2011; 365: 395-409Crossref PubMed Scopus (5891) Google Scholar,7Kinsinger L.S. Anderson C. Kim J. et al.Implementation of lung cancer screening in the Veterans Health Administration.JAMA Intern Med. 2017; 177: 399-406Crossref PubMed Scopus (178) Google Scholar In clinical trials of LCS, participants with screen-detected nodules (vs normal results) demonstrate increased levels of short-term distress.8van den Bergh K.A. Essink-Bot M.L. Borsboom G.J. et al.Short-term health-related quality of life consequences in a lung cancer CT screening trial (NELSON).Br J Cancer. 2010; 102: 27-34Crossref PubMed Scopus (112) Google Scholar,9Brain K. Lifford K.J. Carter B. et al.Long-term psychosocial outcomes of low-dose CT screening: results of the UK Lung Cancer Screening randomised controlled trial.Thorax. 2016; 71: 996-1005Crossref PubMed Scopus (47) Google ScholarTake-home PointsStudy Question: How do patients and clinicians perceive communication after lung cancer screening, including its effects on patient distress?Results: While both clinicians and patients described that communication about large nodules (Lung-RADS 4) was high-quality and met patient needs, clinicians and patients diverged in their impressions of communication about low-risk results, with clinicians believing sending results by letter was clear and well-received, and patients left frustrated, confused, and with lingering concerns about cancer after receiving results by mail.Interpretation: There is a tension between clinicians’ preference for efficiency in disclosing low-risk lung cancer screening results by letter and patients’ strong preference to receive results in a conversation, which allowed their questions and concerns to be addressed and appeared to help mitigate distress about cancer. Study Question: How do patients and clinicians perceive communication after lung cancer screening, including its effects on patient distress? Results: While both clinicians and patients described that communication about large nodules (Lung-RADS 4) was high-quality and met patient needs, clinicians and patients diverged in their impressions of communication about low-risk results, with clinicians believing sending results by letter was clear and well-received, and patients left frustrated, confused, and with lingering concerns about cancer after receiving results by mail. Interpretation: There is a tension between clinicians’ preference for efficiency in disclosing low-risk lung cancer screening results by letter and patients’ strong preference to receive results in a conversation, which allowed their questions and concerns to be addressed and appeared to help mitigate distress about cancer. Similarly, among patients with incidentally detected pulmonary nodules, distress is common, which may in part relate to insufficient patient-clinician communication.10Wiener R.S. Gould M.K. Woloshin S. Schwartz L.M. Clark J.A. What do you mean, a spot?: A qualitative analysis of patients' reactions to discussions with their physicians about pulmonary nodules.Chest. 2013; 143: 672-677Abstract Full Text Full Text PDF PubMed Scopus (92) Google Scholar, 11Freiman M.R. Clark J.A. Slatore C.G. 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; 11: 700-708Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar, 12Slatore C.G. Wiener R.S. Pulmonary nodules: a small problem for many, severe distress for some, and how to communicate about it.Chest. 2018; 153: 1004-1015Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar Patients with incidental nodules often have a poor understanding of what nodules are, the likelihood of cancer, and the evaluation plan.10Wiener R.S. Gould M.K. Woloshin S. Schwartz L.M. Clark J.A. What do you mean, a spot?: A qualitative analysis of patients' reactions to discussions with their physicians about pulmonary nodules.Chest. 2013; 143: 672-677Abstract Full Text Full Text PDF PubMed Scopus (92) Google Scholar,11Freiman M.R. Clark J.A. Slatore C.G. 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; 11: 700-708Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar,13Slatore C.G. Press N. Au D.H. Curtis J.R. Wiener R.S. Ganzini L. What the heck is a “nodule”? A qualitative study of veterans with pulmonary nodules.Ann Am Thorac Soc. 2013; 10: 330-335Crossref PubMed Scopus (37) Google Scholar Encouragingly, patient-centered communication from clinicians is associated with lower distress and greater adherence to evaluation among patients with incidental nodules in real-world settings.14Moseson E.M. Wiener R.S. Golden S.E. et al.Patient and clinician characteristics associated with adherence: a cohort study of veterans with incidental pulmonary nodules.Ann Am Thorac Soc. 2016; 13: 651-659Crossref PubMed Scopus (24) Google Scholar,15Slatore C.G. Wiener R.S. Golden S.E. Au D.H. Ganzini L. Longitudinal assessment of distress among veterans with incidental pulmonary nodules.Ann Am Thorac Soc. 2016; 13: 1983-1991Crossref PubMed Scopus (19) Google Scholar Recognizing the importance of patient-centered communication, guidelines, and Medicare policy emphasize the need for pre-screening shared decision-making.1Mazzone P.J. Silvestri G.A. Patel S. et al.Screening for Lung Cancer: CHEST Guideline and Expert Panel Report.Chest. 2018; 153: 954-985Abstract Full Text Full Text PDF PubMed Scopus (137) Google Scholar, 2Wender R. Fontham E.T. Barrera Jr., E. et al.American Cancer Society lung cancer screening guidelines.CA Cancer J Clin. 2013; 63: 107-117Crossref PubMed Scopus (511) Google Scholar, 3Wood D.E. Kazerooni E. Baum S.L. et al.Lung cancer screening, version 1.2015: featured updates to the NCCN guidelines.J Natl Compr Canc Netw. 2015; 13: 23-34Crossref PubMed Scopus (84) Google Scholar,5Moyer V.A. U.S. Preventive Services Task ForceScreening for lung cancer: U.S. Preventive Services Task Force recommendation statement.Ann Intern Med. 2014; 160: 330-338Crossref PubMed Google Scholar,16Centers for Medicare and Medicaid ServicesDecision memo for screening for lung cancer with low dose computed tomography (LDCT) (CAG-00439N).https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274Date accessed: September 25, 2019Google Scholar The goal is to ensure informed decisions consistent with patient preferences, as well as to prepare patients for the possible finding of a screen-detected nodule. Yet little guidance is provided about how results should be communicated after screening. Moreover, little is known about how results notification occurs in practice, how patients and clinicians perceive this process, and how it affects patient distress. We sought to characterize the perceptions of patients and clinicians about communication of LCS results. We collected data for this qualitative study in two waves. First, we recruited participants from three Veterans Health Administration (VA) hospitals with comprehensive LCS programs. We conducted qualitative interviews with 15 purposively selected clinicians who communicated LCS results (primary care providers [PCPs], pulmonologists, LCS nurse coordinators) and 37 patients who had undergone LCS within the prior year. We deliberately sampled to ensure representation of patients with diverse LCS results (normal/low-risk [eg, lung reporting and data system (Lung-RADS)17American College of RadiologyLung CT screening reporting & data system (Lung-RADS).https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Lung-RadsDate accessed: September 25, 2019Google Scholar 1-2]; indeterminate [Lung-RADS 3]; and suspicious [Lung-RADS 4]), inviting randomly selected individuals in each category from the site’s LCS registry to participate. To increase the number of clinician participants and capture practices in another setting, we conducted a second wave of clinician interviews (n = 21) and two patient focus groups (total n = 12) at a safety-net hospital. Our goal was to characterize perceptions of communication and results notification after LCS from the patient and clinician perspectives, including how their impressions correspond and diverge, and their impressions of how communication may affect distress. Interviews and focus group discussions were facilitated with semi-structured questions (e-Table 1), audio-recorded, and transcribed. Transcripts were analyzed using conventional content analysis.18Hsieh H.F. Shannon S.E. Three approaches to qualitative content analysis.Qual Health Res. 2005; 15: 1277-1288Crossref PubMed Scopus (17440) Google Scholar Team members, including pulmonologists (R. S. W., H. K.) and qualitative experts (J. A. C., E. K., R. B.) performed close readings of transcripts and coded segments representing important concepts that emerged from the data, reaching consensus on themes through iterative discussion. The Bedford VA Hospital (protocol RW0004H) and Boston University Medical Campus (protocol H-34801) institutional review boards approved this study. Participant characteristics are shown in Table 1. Of note, we did not find substantial differences between LCS programs in either clinician or patient perceptions, nor differences by clinician type. Although both clinicians and patients reported that communication about large nodules was high-quality, clinicians and patients diverged in impressions of communication about smaller nodules. In particular, whereas many clinicians assumed that disclosing small nodules by letter was satisfactory to patients, many patients who received results by mail were frustrated, with unanswered questions and concerns. We present results in two main sections: clinician perspectives and patient perspectives.Table 1Characteristics of Study ParticipantsClinicians (n = 36)Primary care provider16 (44%)Pulmonologist15 (42%)Screening nurse coordinator5 (14%)Patients (n = 49)Male40 (82%)Current smoker28 (57%)Screening CT result Normal/low-risk screening result (Lung-RADS 1-2)21 (43%) Indeterminate nodule (Lung-RADS 3)18 (37%) Concerning nodule (Lung-RADS 4)10 (20%)Lung RADS = lung reporting and data system. Open table in a new tab Lung RADS = lung reporting and data system. Clinicians stated that notification processes depended on how clinically concerning LCS findings were (ie, risk of malignancy). All four programs tasked LCS coordinators with disclosing most LCS results, but PCPs or pulmonologists were also involved, particularly for clinically concerning findings. All programs mailed standardized letters to patients with normal, low-risk, or indeterminate results (Lung-RADS 1-3). The LCS coordinator at one site also sent the VA’s patient education pamphlet, explaining pulmonary nodules in lay terms to affected patients (e-Appendix 1). Clinicians assumed this process was well received by patients (Table 2).Table 2Clinician vs Patient Impressions of Disclosure of Small Nodules by LetterClinician Impressions That Letters Are Sufficient to Disclose Screen-Detected NodulesForm letters, and it’s very well-received by the Veterans, much like mammography.…The letters are really well written.—PulmonologistA templated…lung cancer screening CT results letter.…It's very helpful for the patient. It will tell them their results, and…if they need 3, 6 month, or 12 month follow-up.—PCPA letter.…It’s a lung nodule, I don’t know if the doctor really has to have a full discussion on it.—PCPPatient Descriptions of Confusion and Dissatisfaction After Receiving Results by Letter, With Preference for Disclosure in a ConversationI don’t really know what they was talking about having something there that they were going to watch, I don't know what that meant.…It’d make me feel better if I knew….Just kind of wonder what it is.…I’m just kind of waiting on my next appointment.It was a little unnerving.…They need to have a doctor go in and talk to [the patient], explain what’s going on and why....No one really explained anything to me.The terminology in the first letter, I didn't understand what it said.…I won't know until I see her in October.Get a hold of me as soon as you hear because I’d like to hear what the actual findings were, because I don’t understand the medical terms used in the report that I got sent to me. Open table in a new tab In addition, some clinicians proactively called patients, keeping verbal disclosures brief, with an emphasis on evaluation (Table 3). Some did so because they recognized that notification systems could fail, whereas others did so in acknowledgment that waiting for results could be distressing:I call patients on all my results…because I’ve been burned before.…Assumed somebody else would have told the patient.—PCPCall, because they’re usually pretty worried.—PCPTable 3Clinician vs Patient Preferences for Verbal Disclosure of Small LCS-Detected NodulesClinicians Typically Aim for Brief Verbal Disclosure of Results, With Emphasis on Follow-up PlanCall them and probably focus on the test results….My goal isn’t to spend a long time on the phone.—PCPI will tell them, ‘There’s a spot in your lung, it’s probably scar tissue that’s related to smoking.…It's sort of like having a freckle on your skin.… It's very small. If we didn't look, we wouldn't have seen it. We just need to do a follow-up to make sure it's not something that's growing.’—PCPI’ll usually call them and say, ‘Listen you have a nodule. It doesn’t look like anything. They’re going to send you to a nodule clinic and follow-up [scan] in six months to a year.—PCPGive them a call, so you don’t keep them waiting.…‘We don’t see anything of concern, but we do see these nodules, we need to continue to follow them.’—PulmonologistI always call them with the result…sometimes just leave a message with my number to call back if there’s any questions. Otherwise I’ll [say], ‘Result looks good. We’d like to have another one in one year later. You’ll get the letter with the next scheduled appointment, but you can call me with some questions.’ Some people call me back, some don’t.—LCS coordinatorWe tell them, ‘This is a frequent finding, this is what we ordinarily see in smokers. Our only interest is whether they’re growing and we’ll just keep an eye on them. If they grow, we’ll do something about it.'—PulmonologistPatient Reports of Satisfying Verbal Disclosures Emphasize Role of Clinician Explaining Nodules, Addressing Concerns, and Answering QuestionsI had the CAT scan and I think the very same day [the nurse coordinator] called me at home and gave me the results of it, and she said…that it was very small and that they would do another CAT scan in six months, and not to worry.…It made me a little nervous until I asked her if it was cancerous and she said, 'No, we’re not saying that it’s cancerous, it’s just something to keep an eye on'....She explained everything.…The few questions I did have she answered…thoroughly and she was excellent.My primary doctor, he called me right back.…He said…I had that [nodule], and not to worry about it and he was going to schedule another one in a couple of months.…Basically he said he didn’t know if it was there before or how long it’s been there.…He told me what was going on and I really respect that, you know, it’s a good thing.I spoke with a nurse [coordinator] who was very helpful in answering my questions.…She took the time…to explain things to me.…She put me at ease.The spot’s not necessarily an indication of cancer, that it was a number of things that the spots could be, that was discussed in the follow-up call after the screening. They told me…that another [CT] would be taken some months down the road, and of course the results would be compared to decide whether or not there was any growth. If there was growth of course that would most likely indicate that lung cancer was evident.…If the spots hadn't grown, it still could be the beginnings of lung cancer, but then it also could be as a result of lung injury, ie, pneumonia or toxic chemical exposure.….[My] questions were answered and I was satisfied.They actually called and said, ‘We thought you probably might want to know. Relax, things are looking very good. You’ll get a written detailed analysis of the test, but just to let you know that, don’t worry, there was no cancer.’ …[The letter] did say something about a small little diameter kind of polyp or something which was non-cancerous, but that’s why they recommended to continue to do this every year.…I was feeling, you know, pretty joyous. Open table in a new tab But many clinicians relied on patients to reach out with questions or concerns, even if they did recognize the potential for distress: On that letter is, ’If you have any concerns or want to speak to someone, there’s contact information for [the LCS coordinator].’ Of course if there’s someone who’s very concerned, I feel like that’s my job as a pulmonologist to talk them down or help them understand what’s going on.—Pulmonologist Clinicians acknowledged that it was difficult to gauge patient reactions to disclosures by phone or letter: It’s not something that you are face-to-face, making eye contact, you don’t know what the response is—PCP. Clinicians tried to mitigate patient concerns by using reassuring language when disclosing a screen-detected nodule (Fig 1), and some assumed that patients were therefore not distressed: I would say [patients] respond pretty positively because I present it pretty positively, that it's most likely nothing.—Pulmonologist But other clinicians acknowledged that screen-detected nodules could be upsetting and warranted a more nuanced conversation: They’re just worried about it. It’s usually a conversation.…What’s a nodule, what does this mean, and all those type of questions—PCP. These clinicians believed patients valued the opportunity to discuss the nodule and its evaluation: I’ve reported [results] by phone.…They seem appreciative to have heard from me and then we decide where to go next.—Pulmonologist Some clinicians noted that prescreening shared decision-making facilitated subsequent disclosure of nodules and helped prevent distress:[Before] screening, we raise the possibility that there’d be an abnormality, and it’s a little easier to call them up and say we need to do some further testing.—PulmonologistI remind them of our previous conversation, and I reassure them.…I asked [a patient with a nodule], ‘How are you? Do you need to talk?’ and he [said], ‘Oh I’m fine because I expected this.’”—LCS coordinator By contrast, other clinicians noted that pre-screening shared decision-making was insufficient to prevent patient concerns about LCS-detected nodules:If it’s a nodule, they [ask], ‘is it cancer?’ That’s another long conversation about the difference between cancer and not-cancer nodules, and the concern, and follow-up. I think nodules confuse them, even after all the prep work you try to do. It’s a foreign topic to them.”—PCP Clinicians almost always disclosed nodules with a higher cancer risk (Lung-RADS 4) in conversations: I don’t send them a letter or anything because I don’t think that’s tactful. I think it needs to come by mouth that they need to have a work-up—LCS coordinator. Although acknowledging that in-person disclosure would be ideal, clinicians pragmatically favored phone calls: I call.…I would like to give some of this news in person....It’s just not practical to have everyone schedule an appointment—PCP. Clinicians emphasized the importance of addressing the possibility of cancer, ensuring patients understood the evaluation plan, and tailoring discussions to support patients:Calling a patient, saying, ‘We think you have a cancer, [but] we’re not sure. These are the steps, this is what I’m going to order. I want you to understand.’ …You’re basically handholding them through the process, and some people need more and some people need less.”—LCS coordinator Almost all patients, regardless of the ultimate findings of LCS, noted some distress, particularly while awaiting results. How quickly distress was resolved, and their understanding of the nodule and evaluation plan, depended on how and when they received LCS results. Those who were notified by letter—or could not recall receiving results at all—had unanswered questions and lingering concerns, even if results were not clinically concerning; those who learned of a nodule during a conversation had the opportunity to have their questions and concerns addressed, and thus experienced less distress. Some patients could not recall ever receiving LCS results. Although many assumed that “no news is good news,” some felt lingering discomfort, particularly about the possibility of cancer:I was a little bit worried about it, but I said, 'God I hadn’t heard nothing so it must be good.’ But like I say I don’t really know.A little bit anxious…I was left in the dark....Because of not hearing anything, I assumed that things are not too bad from the test, but I still have questions. Echoing clinician accounts, most patients with normal, low-risk, or indeterminate findings (Lung-RADS 1-3) reported receiving LCS results by letter. Several were frustrated by medical jargon and had unanswered questions and concerns (Table 2). Many expressed a preference to learn of a screen-detected nodule through a conversation, and they were eager to discuss the nodule at their next clinic visit. Some patients who learned of normal results by letter expressed distrust of LCS accuracy and fatalism about an inevitable lung cancer diagnosis. For some this was a persistent source of worry:I got a letter back saying that everything was negative, turned out to be okay.…All those years I was smoking, I was wondering if something caught up with me.…It was a relief but how do I know if it’s the truth?...Just keep wondering and wondering. By contrast, other patients, such as those who were already familiar with pulmonary nodules, were unfazed by receiving results by letter: They sent me a letter saying that they seen spots. They wanted to…check me every year,…make sure they don’t get cancerous.…I know a couple friends [with nodules], so I don’t really get too scared. Patients who reported receiving results in a conversation, usually by phone, appreciated the opportunity to hear their clinician’s explanation of the results and planned evaluation, to have their questions answered, and to be reassured (Table 3). Some patients valued that their clinician had set expectations by alluding to the possibility of a screen-detected nodule during pre-screening shared decision-making:My doctor told me, before my test, he said, ‘If there's anything wrong, we'll talk about it afterwards.’ …He was making plans. He was telling me ahead of time.…I have a very good doctor. By contrast, patients who felt their clinicians paid inadequate attention to their nodule were frustrated. For example, one patient interpreted his clinicians’ remarks as trivializing his nodules as the expected consequence of smoking and not taking time to resolve his concerns:They mentioned that there was a couple of spots on my lung, which they said there wasn’t any" @default.
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• W3022521788 title "Patient vs Clinician Perspectives on Communication About Results of Lung Cancer Screening" @default.
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