Katsampouris Evangelos, Creamer Andrew W, Prendecki Ruth, Clark Elizabeth, Dickson Jennifer L, Lee Richard, Janes Samuel M, Duffy Stephen W, Quaife Samantha L
Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, UK.
BMJ Open Respir Res. 2025 Jun 12;12(1):e002498. doi: 10.1136/bmjresp-2024-002498.
Low-dose CT screening reduces lung cancer mortality among high-risk populations, and detects indeterminate pulmonary nodules that require subsequent surveillance. This period of uncertainty could result in patients experiencing lung cancer-related distress, anxiety and worry. This multicentre qualitative study explored patients' experiences and psychological responses to disclosing and communicating nodule surveillance.
Eligible participants were purposively sampled from four lung cancer screening sites in England to ensure diversity with respect to region, service setting, individual characteristics and surveillance pathways. Thirty-nine patients (23 females), aged 55-80 years, who had undergone their first nodule surveillance scan, participated in one-to-one remote semi-structured interviews. Audio-recorded interviews were transcribed verbatim and analysed using applied thematic analysis.
Participants reported a broad spectrum of psychological responses to the way their nodule finding was communicated and their experiences of undergoing surveillance. Understanding what a nodule is and what a surveillance process entails was important for explaining patient psychological reactions and behavioural outcomes. Perceived support and effective communication with healthcare professionals were instrumental in decreasing patients' distress, uncertainty and concern, and increasing reassurance, knowledge about nodules and psychological preparation for the possibility of surveillance.
While current letter-based means of nodule disclosure and communication were acceptable to patients, there is a need to improve the way nodules are communicated using lay language. Brief verbal consultations with healthcare professionals could provide clearer guidance to patients undergoing surveillance and increase their understanding about the surveillance process and subsequent scans, resulting in improved affective, behavioural and cognitive outcomes.
低剂量CT筛查可降低高危人群的肺癌死亡率，并能检测出需要后续监测的不确定肺结节。这段不确定时期可能导致患者出现与肺癌相关的困扰、焦虑和担忧。这项多中心定性研究探讨了患者在披露和交流结节监测情况时的经历和心理反应。
从英国的四个肺癌筛查地点有目的地抽取符合条件的参与者，以确保在地区、服务机构、个体特征和监测途径方面具有多样性。39名年龄在55至80岁之间、已接受首次结节监测扫描的患者（23名女性）参与了一对一的远程半结构化访谈。对录音访谈进行逐字转录，并使用应用主题分析法进行分析。
参与者报告了对其结节发现的传达方式以及监测经历的广泛心理反应。了解结节是什么以及监测过程涉及什么对于解释患者的心理反应和行为结果很重要。感受到的来自医疗保健专业人员的支持以及有效的沟通有助于减轻患者的困扰、不确定性和担忧，并增强安心感、关于结节的知识以及对监测可能性的心理准备。
虽然目前基于信件的结节披露和交流方式患者可以接受，但仍需要改进使用通俗易懂的语言来传达结节情况的方式。与医疗保健专业人员进行简短的口头咨询可以为接受监测的患者提供更清晰的指导，并增加他们对监测过程和后续扫描的理解，从而改善情感、行为和认知结果。
