• Michael K Gould, Beth Creekmur, Lihong Qi, Sara E Golden, Celia P Kaplan, Eric Walter, Richard A Mularski, Laszlo T Vaszar, Kathleen Fennig, Julie Steiner, Evan de Bie, Visanee V Musigdilok, Danielle A Altman, Debra S Dyer, Karen Kelly, Diana L Miglioretti, Renda Soylemez Wiener, Christopher G Slatore, and Rebecca Smith-Bindman.
• Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA. Electronic address: Michael.k.gould@kp.org.
• Chest. 2023 Dec 1; 164 (6): 156015711560-1571.

BackgroundAnxiety and emotional distress have not been studied in large, diverse samples of patients with pulmonary nodules.Research QuestionHow common are anxiety and distress in patients with newly identified pulmonary nodules, and what factors are associated with these outcomes?Study Design And MethodsThis study surveyed participants in the Watch the Spot Trial, a large, pragmatic clinical trial of more vs less intensive strategies for radiographic surveillance of patients with small pulmonary nodules. The survey included validated instruments to measure patient-centered outcomes such as nodule-related emotional distress (Impact of Event Scale-Revised) and anxiety (Six-Item State Anxiety Inventory) 6 to 8 weeks following nodule identification. Mixed-effects models were used to compare outcomes between study arms following adjustment for potential confounders and clustering within enrollment site, while also examining a limited number of prespecified explanatory factors, including nodule size, mode of detection, type of ordering clinician, and lack of timely notification prior to contact by the study team.ResultsThe trial enrolled 34,699 patients; 2,049 individuals completed the baseline survey (5.9%). Respondents and nonrespondents had similar demographic and nodule characteristics, although more respondents were non-Hispanic and White. Impact of Event Scale-Revised scores indicated mild, moderate, or severe distress in 32.2%, 9.4%, and 7.2% of respondents, respectively, with no difference in scores between study arms. Following adjustment, greater emotional distress was associated with larger nodule size and lack of timely notification by a clinician; distress was also associated with younger age, female sex, ever smoking, Black race, and Hispanic ethnicity. Anxiety was associated with lack of timely notification, ever smoking, and female sex.InterpretationAlmost one-half of respondents experienced emotional distress 6 to 8 weeks following pulmonary nodule identification. Strategies are needed to mitigate the burden of distress, especially in younger, female, ever smoking, and minoritized patients, and those with larger nodules.Clinical Trial RegistrationClinicalTrials.gov; No.: NCT02623712; URL: www.Clinicaltrialsgov.Copyright © 2023 American College of Chest Physicians. All rights reserved.

16 keywords...

hide…