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Abstract
Background
The
hundreds of thousands of patients found to have a potentially malignant
pulmonary nodule each year are faced with tremendous uncertainty
regarding what the nodule is and how it should be evaluated.
Objective
To explore patients’ responses to the detection and evaluation of a pulmonary nodule.
Design
Qualitative
study based on four focus-group discussions. We performed inductive
analysis using principles of grounded theory to identify themes relating
to responses to the nodule and strategies to manage uncertainty.
Setting and participants
Twenty-two patients from two medical centres who were undergoing surveillance for an indeterminate pulmonary nodule.
Results
Patient
responses to an indeterminate pulmonary nodule were varied and evolved
over time. Although almost all patients reported an initial fear about
cancer, subsequent depictions of the nodule diverged into four types
defined on two dimensions: cognitive (‘it's cancer’ vs. ‘I don't know
what it is’ vs. ‘it's nothing serious’) and emotional (anxiety vs.
equanimity). Most eventually accepted that the nodule was unlikely to be
malignant; however, some remained anxious, convinced the nodule could
turn into cancer at any time and should be aggressively monitored for
life. Patients used results of surveillance tests as well as their own
strategies (e.g. vigilance for symptoms, information-seeking,
contemplating and controlling modifiable risk factors, avoidance, faith)
to manage uncertainty.
Conclusions
Surveillance
for a pulmonary nodule can weigh heavily on some patients for months or
years. Our findings may help clinicians prepare patients with a newly
detected pulmonary nodule for the burden of the prolonged uncertainty of
surveillance.
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