Recommendations to Improve Management of Incidental Pulmonary Nodules in Canada: Expert Panel Consensus
- PMID: 38869196
- DOI: 10.1177/08465371241257910
Recommendations to Improve Management of Incidental Pulmonary Nodules in Canada: Expert Panel Consensus
Abstract
Introduction: Incidental pulmonary nodules (IPN) are common radiologic findings, yet management of IPNs is inconsistent across Canada. This study aims to improve IPN management based on multidisciplinary expert consensus and provides recommendations to overcome patient and system-level barriers. Methods: A modified Delphi consensus technique was conducted. Multidisciplinary experts with extensive experience in lung nodule management in Canada were recruited to participate in the panel. A survey was administered in 3 rounds, using a 5-point Likert scale to determine the level of agreement (1 = extremely agree, 5 = extremely disagree). Results: Eleven experts agreed to participate in the panel; 10 completed all 3 rounds. Consensus was achieved for 183/217 (84.3%) statements. Panellists agreed that radiology reports should include a standardized summary of findings and follow-up recommendations for all nodule sizes (ie, <6, 6-8, and >8 mm). There was strong consensus regarding the importance of an automated system for patient follow-up and that leadership support for organizational change at the administrative level is of utmost importance in improving IPN management. There was no consensus on the need for standardized national referral pathways, development of new guidelines, or establishing a uniform picture archiving and communication system. Conclusion: Canadian IPN experts agree that improved IPN management should include standardized radiology reporting of IPNs, standardized and automated follow-up of patients with IPNs, guideline adherence and implementation, and leadership support for organizational change. Future research should focus on the implementation and long-term effectiveness of these recommendations in clinical practice.
Keywords: Delphi panel; incidental pulmonary nodule; lung cancer; multidisciplinary experts; patient management.
Conflict of interest statement
Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: G.C.D., S.L., M.C.T., C.F., C.D., S.S., J.H., J.T., A.V.G., J.S., and D.M. received unrestricted support for meetings, planning and data collection, manuscript writing and editing, participating in the Delphi panel, and consulting fees from AstraZeneca. G.C.D. received research funding from MaRS/Merck & Co., Inc. and from Pfizer Inc.; honoraria from Merck & Co., Inc. and GSK Medical; and has received grants outside the submitted work paid directly to Queen’s University from the Ontario Lung Association and Ontario Thoracic Society. G.C.D. serves as the Canadian Thoracic Society Choosing Wisely Canada Working Group chair. J.S. received consulting fees from AstraZeneca to support the conduction of this study and was an employee of Amaris Consulting at the time of this study. D.G. and P.M. received consulting fees from AstraZeneca to support the conduction of this study and are employees of Amaris Consulting. The authors have no other conflicts of interest to declare.