Less Versus More Intensive Surveillance of Pulmonary Nodules Detected Incidentally or by Screening: A Survey of Radiologist Beliefs About Guidelines Implemented in the Watch the Spot Trial.
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| Názov: | Less Versus More Intensive Surveillance of Pulmonary Nodules Detected Incidentally or by Screening: A Survey of Radiologist Beliefs About Guidelines Implemented in the Watch the Spot Trial. |
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| Autori: | Gould MK; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California. Electronic address: Michael.k.gould@kp.org., Creekmur B; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California., Qi L; Department of Public Health Sciences, School of Medicine, University of California, Davis, California., de Bie E; Department of Public Health Sciences, School of Medicine, University of California, Davis, California., Aberle DR; Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California., Dyer DS; Department of Radiology, National Jewish Health, Denver, Colorado., Golden S; VA Portland Healthcare System, Portland, Oregon., Kaplan CP; Department of Medicine, University of California, San Francisco, California., Mularski RA; Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon., Steiner JS; Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado., Steltz JP; Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Vachani A; Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Wiener RS; Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts; The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts., Kelly K; International Association for the Study of Lung Cancer, Denver, Colorado., Smith-Bindman R; Departments of Radiology and Biomedical Imaging and Epidemiology and Biostatistics and the Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California., Miglioretti DL; Department of Public Health Sciences, School of Medicine, University of California, Davis, California; Kaiser Permanente Washington Health Research Institute, Seattle, Washington. |
| Zdroj: | Journal of the American College of Radiology : JACR [J Am Coll Radiol] 2025 Dec; Vol. 22 (12), pp. 1589-1597. |
| Spôsob vydávania: | Journal Article; Randomized Controlled Trial |
| Jazyk: | English |
| Informácie o časopise: | Publisher: Elsevier Country of Publication: United States NLM ID: 101190326 Publication Model: Print Cited Medium: Internet ISSN: 1558-349X (Electronic) Linking ISSN: 15461440 NLM ISO Abbreviation: J Am Coll Radiol Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: New York, NY : Elsevier, c2004- |
| Výrazy zo slovníka MeSH: | Guideline Adherence*/statistics & numerical data , Solitary Pulmonary Nodule*/diagnostic imaging , Lung Neoplasms*/diagnostic imaging , Practice Guidelines as Topic* , Tomography, X-Ray Computed* , Practice Patterns, Physicians'*/statistics & numerical data , Radiologists*/statistics & numerical data , Radiologists*/psychology , Multiple Pulmonary Nodules*/diagnostic imaging , Attitude of Health Personnel*, Humans ; Female ; Male ; Incidental Findings ; Middle Aged ; Surveys and Questionnaires ; Aged |
| Abstrakt: | Objective: To examine radiologists' beliefs about protocols for less versus more intensive surveillance imaging in patients with small pulmonary nodules. Methods: We developed a self-administered survey to measure familiarity, adherence, and satisfaction with assigned protocols for surveillance as implemented in an unblinded, cluster-randomized, pragmatic trial of pulmonary nodule evaluation. Protocols were modeled on recommendations from the Fleischner Society (for incidental nodules) and the ACR's Lung CT Screening Reporting and Data System (for screening-detected nodules). We compared responses by study arm using multivariable logistic regression. Results: The survey was completed by 153 of 514 invited radiologists (29.8%), including 76 responders in the less intensive study arm and 77 in the more intensive arm. For incidentally detected nodules, large majorities of responders in both study arms reported at least moderate familiarity (>88%) and at least very frequent adherence (>94%) with assigned protocols for surveillance, and over 70% agreed that benefits of adherence outweigh the harms. Responders in the less intensive arm were more likely to agree that their preferred guideline was in use during the study (78.9% versus 45.5%; adjusted odds ratio [aOR] 13.9, 95% confidence interval [CI] 4.2-45.7), were more likely to believe that the supporting evidence for the assigned guideline was strong or very strong (76.3% versus 54.6%; aOR 2.40, 95% CI 1.13-5.07), and were less likely to believe that follow-up recommendations were too frequent (25.0% versus 41.6%; aOR 0.46, 95% CI 0.22-0.96). For screening-detected nodules, responders in both study arms reported high levels of protocol familiarity, adherence, and agreement that benefits of adherence outweigh the harms. Conclusion: In this pragmatic clinical trial, practicing radiologists reported high levels of familiarity, adherence, and agreement with assigned guidelines for pulmonary nodule evaluation. Perceptions of the supporting evidence and beliefs about the frequency of surveillance were more favorable in the less intensive study arm, likely reflecting radiologists' preference for and comfort with guidelines currently in use. (Copyright © 2025 American College of Radiology. All rights reserved.) |
| Contributed Indexing: | Keywords: Adherence; clinical practice guidelines; pulmonary nodule; radiology practice; survey methods |
| Entry Date(s): | Date Created: 20251203 Date Completed: 20251203 Latest Revision: 20251203 |
| Update Code: | 20251204 |
| DOI: | 10.1016/j.jacr.2025.09.022 |
| PMID: | 41338713 |
| Databáza: | MEDLINE |
Nájsť tento článok vo Web of Science | Abstrakt: | Objective: To examine radiologists' beliefs about protocols for less versus more intensive surveillance imaging in patients with small pulmonary nodules.<br />Methods: We developed a self-administered survey to measure familiarity, adherence, and satisfaction with assigned protocols for surveillance as implemented in an unblinded, cluster-randomized, pragmatic trial of pulmonary nodule evaluation. Protocols were modeled on recommendations from the Fleischner Society (for incidental nodules) and the ACR's Lung CT Screening Reporting and Data System (for screening-detected nodules). We compared responses by study arm using multivariable logistic regression.<br />Results: The survey was completed by 153 of 514 invited radiologists (29.8%), including 76 responders in the less intensive study arm and 77 in the more intensive arm. For incidentally detected nodules, large majorities of responders in both study arms reported at least moderate familiarity (>88%) and at least very frequent adherence (>94%) with assigned protocols for surveillance, and over 70% agreed that benefits of adherence outweigh the harms. Responders in the less intensive arm were more likely to agree that their preferred guideline was in use during the study (78.9% versus 45.5%; adjusted odds ratio [aOR] 13.9, 95% confidence interval [CI] 4.2-45.7), were more likely to believe that the supporting evidence for the assigned guideline was strong or very strong (76.3% versus 54.6%; aOR 2.40, 95% CI 1.13-5.07), and were less likely to believe that follow-up recommendations were too frequent (25.0% versus 41.6%; aOR 0.46, 95% CI 0.22-0.96). For screening-detected nodules, responders in both study arms reported high levels of protocol familiarity, adherence, and agreement that benefits of adherence outweigh the harms.<br />Conclusion: In this pragmatic clinical trial, practicing radiologists reported high levels of familiarity, adherence, and agreement with assigned guidelines for pulmonary nodule evaluation. Perceptions of the supporting evidence and beliefs about the frequency of surveillance were more favorable in the less intensive study arm, likely reflecting radiologists' preference for and comfort with guidelines currently in use.<br /> (Copyright © 2025 American College of Radiology. All rights reserved.) |
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| ISSN: | 1558-349X |
| DOI: | 10.1016/j.jacr.2025.09.022 |