Optimizing Follow-up of Incidental Findings: A Structured Survey of Primary Care Providers
*Stephanie D Talutis1, *Ellen Childs2, *Philip E Knapp1, *Avneesh Gupta1, *Cleopatra Ferrao1, David McAneny1, *F. Thurston Drake1
1Boston University, Boston, MA;2Boston University School of Public Health, Boston, MA
Understand management strategies among PCPs for incidental pulmonary nodules (PNs) and adrenal nodules (ANs).
Surveys of practice patterns for incidental PNs/ANs.
Participants were randomly assigned to a survey +/- guidelines for management of incidentalomas.
Main Outcome Measures
Participants were asked about management strategies and barriers faced, then asked to consider clinical vignettes. Responses were compared between those with/without guidelines.
On average, PCPs encounter 4(SD=6) incidentalomas/month, half from studies ordered by another provider. The most important resources to guide follow-up are radiology report recommendations(PN=80%, AN=74%) and Up-To-Date(PN=59%, AN=65%). While 48% of PCPs had encountered an incidental PN diagnosed as lung cancer, substantially fewer(<10%) had encountered adrenal pathologies among incidental ANs. For PNs, the most significant barrier was insufficient time/support to follow results longitudinally(69%). For ANs, it was uncertainty about tests to order(68%). Themes regarding the "ideal" system: automated report-delivery and follow-up tests, longitudinal tracking tools, "virtual consultations," and decision guides within EMR. Differences between groups with and without guidelines were observed. Access to guidelines was significantly associated with a correct choice among lower-risk AN scenarios; there was little impact for higher-risk scenarios (Table).
PCP input is necessary to design an effective system. Easy access to straightforward clinical guidelines may improve decision-making, especially for lower-risk lesions that still require action. The radiology report is the most utilized source of information guiding next steps. Strategies to improve follow-up must focus beyond simply alerting PCPs and should include decision guides, tracking capabilities, and EMR-integration.
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