Abstract Rationale Two million lung nodules are detected annually. Most lung nodules have an intermediate probability of cancer (10%-70%), and patients and clinicians must choose between surveillance imaging and biopsy. Current guidelines suggest performing a positron emission tomography (PET) scan to inform this decision, but clinical use varies widely. While PET is non-invasive and may help avoid unnecessary biopsies, false negatives may delay diagnosis. We surveyed patients and clinicians to assess their priorities in choosing PET versus biopsy in evaluation of intermediate probability pulmonary nodules (IPPN). Methods We conducted a concurrent mixed methods study involving: a staff-administered survey including 10 visual analog scale (VAS) and multiple-choice questions to adult, English-speaking patients attending routine pulmonary clinic visits; and an anonymous online survey including 12 Likert and multiple-choice questions administered to pulmonary clinicians (Table 1). Patients received a brief introduction on the risks, benefits, and diagnostic performance of PET and biopsy for detection of IPPNs, and questions were written at a 5th grade reading level to enhance accessibility. Surveys assessed the importance of safety, cost, diagnostic accuracy, and respondent likelihood of choosing or recommending PET versus biopsy in a simulated evaluation of an IPPN. Descriptive statistics summarized respondent demographics and responses. A Mann-Whitney test assessed the statistical significance of within-respondent differences in likelihood ratings for PET versus biopsy. Results Most patient respondents were female (n = 64, 64%) and mean age was 58.8 (SD = 17.0). The highest rated factor in choosing PET versus biopsy was “knowing for sure the nodule is cancer.” Patients rated their likelihood of choosing PET significantly higher than biopsy (7.9 versus 6.0, p 0.0005). Clinicians rated “patient risk assessment” and “need for diagnostic certainty” highest and were more likely to recommend biopsy over PET, but this difference was not statistically significant (6.2 versus 5.7, p 0.49). Most patients (n = 70, 70%) and clinicians (n = 30, 64%) selected the most important outcome of IPPN management as “making the correct choice the first time (performing biopsy for malignant nodules and surveillance for non-malignant nodules)” over “time to biopsy” and “avoidance of unnecessary biopsy.” Conclusions Our findings suggest that patients prefer PET over biopsy as the initial step in IPPN management. While patients and clinicians valued diagnostic certainty, patient preferences and clinician recommendations did not coincide, highlighting the importance of shared decision making in this complex and common clinical scenario. This abstract is funded by: None
Goodfellow et al. (Fri,) studied this question.