Does this lung nodule need urgent review? A discrete choice experiment of Australian general practitioners

Nodule net: A centralized prospective lung nodule tracking and safety-net program

BACKGROUND

Inadequate follow-up of suspicious lung nodules can result in diagnostic delays and potential progression to advanced lung cancer. In 2015, a multidisciplinary lung nodule management program, Nodule Net, was implemented to increase the timely follow-up rate. In this study, we sought to evaluate the effectiveness of the program.

METHODS

2398 chest CT reports were reviewed for the presence of a lung nodule. Baseline demographics, nodule characteristics, and follow-up recommendations were collected. For reports that did not include structured recommendations, Fleischner Society guidelines were applied if appropriate. The rate of follow-up imaging was recorded and compared with historical rates.

RESULTS

Lung nodules were reported on 1367 (57%) of scans. Of the 632 participants with recommendations for follow-up, the Nodule Net nurse navigator was notified on 523 (83%). Of these, 408 (78%) completed follow-up, compared to 57/109 (52%) in those who were not reported to Nodule Net tracking system (risk ratio: 1.49, 95% CI: 1.24-1.79, p-value < 0.05). Out of these 408, nodule net outreach was required to prompt the follow-up in 116 (28%). Of these, a lung malignancy was diagnosed in 4 (4%).

CONCLUSIONS

Management of lung nodules is a complex process. Implementation of a lung nodule tracking program led to a significant increase in the completion of recommended follow-up imaging compared with usual care. Developing a comprehensive lung nodule program using an automated software system rather than manual processes to refer and track incidental findings may further reduce barriers to completion of follow-up.

Systematic review and validity assessment of methods used in discrete choice experiments of primary healthcare professionals

INTRODUCTION

Discrete choice experiments (DCEs) have been used to measure patient and healthcare professionals preferences in a range of settings internationally. Using DCEs in primary care is valuable for determining how to improve rational shared decision making. The purpose of this systematic review is to assess the validity of the methods used for DCEs assessing the decision making of healthcare professionals in primary care.

MAIN BODY

A systematic search was conducted to identify articles with original data from a discrete choice experiment where the population was primary healthcare professionals. All publication dates from database inception to 29th February 2020 were included. A data extraction and validity assessment template based on guidelines was used. After screening, 34 studies met the eligibility criteria and were included in the systematic review. The sample sizes of the DCEs ranged from 10 to 3727. The published DCEs often provided insufficient detail about the process of determining the attributes and levels. The majority of the studies did not involve primary care healthcare professionals outside of the research team in attribute identification and selection. Less than 80% of the DCEs were piloted and few papers investigated internal or external validity.

CONCLUSIONS

For findings to translate into improvements in rational shared decision making in primary care DCEs need to be internally and externally valid and the findings need to be able to be communicated to stakeholders in a way that is understandable and relevant.