美国当前肺结节评估与管理:一项混合方法研究
Contemporary Pulmonary Nodule Evaluation and Management in the U.S.: A Mixed Methods Study.
作者
作者单位
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania, Philadelphia, PA; Penn Center for Cancer Care Innovation at the Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA. Electronic address: roger.kim@pennmedicine.upenn.edu.
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania, Philadelphia, PA.
- Mixed Methods Research Lab, Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA.
- Penn Center for Cancer Care Innovation at the Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mixed Methods Research Lab, Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA; Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA.
摘要
中文
有效的肺结节(PN)评估与管理对于早期肺癌的诊断、同时避免不必要的有创操作至关重要。关于临床医师如何管理肺结节以及应优先改进哪些方面,目前仍存在重要知识空白。哪些因素影响临床医师的肺结节评估与管理实践?优化临床诊疗中存在的感知障碍有哪些?2024 年 8 月至 2025 年 12 月,我们对管理肺结节患者的临床医师进行了一项探索性序贯混合方法研究。首先,我们对来自多个专科的 40 位临床医师进行了半结构化定性访谈,然后对访谈记录进行主题分析,以开发并实施全国性的定量在线调查。我们对调查数据进行了描述性分析,将结果与具有代表性的访谈引述进行三角验证,并根据先验研究目标和定性发现开展探索性分析,评估与调查应答相关的因素。在接受电子邮件调查邀请的 3,588 位美国临床医师中,192 位(5.4%)完成了调查,涵盖普通呼吸科、介入呼吸科、胸外科及其他专科。大多数临床医师(70.8%)报告使用风险评估工具评估肺结节癌变风险,其中临床风险预测模型(70.3%)较商业生物标志物(18.8%)更为常用。大多数参与者(63.5%)认为理想的风险评估工具应优先避免漏诊肺癌,其次才是避免不必要的有创操作。临床医师普遍认同肺结节评估具有挑战性(71.4%),需要共同决策(95.8%)、多学科协作(91.1%)和持续改进(85.9%)。仅 50.5% 报告拥有提供最佳肺结节诊疗所需的临床资源。参与者将肺结节追踪与风险评估工具列为改善肺结节临床诊疗的首要优先事项。临床医师认为肺结节评估具有挑战性,需要多学科协作、共同决策和持续改进,但许多医师缺乏提供最佳诊疗所需的充足资源。未来工作应聚焦于改进系统层面的肺结节追踪和癌变风险评估。
English
Effective pulmonary nodule (PN) evaluation and management is essential to diagnosing early-stage lung cancers while avoiding unnecessary invasive procedures. Key knowledge gaps exist regarding how clinicians manage PNs and which opportunities for improvement should be prioritized. Which factors contribute to clinicians' PN evaluation and management practices, and what are perceived barriers to optimal clinical care? From August 2024 to December 2025, we performed an exploratory sequential mixed methods study of clinicians who care for patients with PNs. First, we conducted semi-structured qualitative interviews with 40 clinicians across multiple specialties before thematically analyzing interview transcripts to develop and administer a quantitative online survey nationwide. We descriptively analyzed survey data, triangulated results with representative interview quotes, and performed exploratory analyses assessing factors associated with survey responses, selected by a priori study objectives and qualitative findings. Of 3,588 U.S. clinicians e-mailed to participate in the survey, 192 (5.4%) across general pulmonology, interventional pulmonology, thoracic surgery, and other specialties completed it. Most clinicians (70.8%) reported using risk assessment tools to evaluate PN cancer risk, with clinical risk prediction models (70.3%) more commonly used than commercial biomarkers (18.8%). Most participants (63.5%) believed that an ideal risk assessment tool should prioritize not missing a lung cancer diagnosis rather than avoiding unnecessary invasive procedures. Clinicians generally agreed that PN evaluation is challenging (71.4%) and requires shared decision-making (95.8%), multidisciplinary collaboration (91.1%), and improvement (85.9%). Only 50.5% reported having the clinical resources necessary to provide optimal PN care. Participants ranked PN tracking and risk assessment tools as the top priorities for improving PN clinical care. Clinicians find PN evaluation challenging, requiring multidisciplinary collaboration, shared decision-making, and improvement, but many lack adequate resources to provide optimal care. Future efforts should focus on improving system-level PN tracking and cancer risk assessment.
分类与指标
- 研究类型
- 临床研究
- 病种
- 肺癌
- JCR 分区
- Q1
- 影响因子
- 9.8
- 新锐分区
- 1区