CHEST pulmonary最新文献

{"title":"Navigational Bronchoscopy vs CT Scan-Guided Transthoracic Needle Biopsy for the Diagnosis of Indeterminate Lung Nodules","authors":"Robert J. Lentz MD ,&nbsp;Katherine Frederick-Dyer MD ,&nbsp;Virginia B. Planz MD ,&nbsp;Tatsuki Koyama PhD ,&nbsp;Matthew C. Aboudara MD ,&nbsp;Briana Swanner BS ,&nbsp;Lance Roller MS ,&nbsp;See-Wei Low MD ,&nbsp;Cristina Salmon MD ,&nbsp;Sameer K. Avasarala MD ,&nbsp;Todd C. Hoopman MD ,&nbsp;Momen M. Wahidi MD ,&nbsp;Kamran Mahmood MD, MPH ,&nbsp;George Z. Cheng MD, PhD ,&nbsp;James M. Katsis MD ,&nbsp;Jonathan S. Kurman MD ,&nbsp;Pierre-François D’Haese PhD ,&nbsp;Joyce Johnson MD ,&nbsp;Eric L. Grogan MD, MPH ,&nbsp;Charla Walston AGACNP-BC ,&nbsp;Fabien Maldonado MD","doi":"10.1016/j.chpulm.2024.100050","DOIUrl":"10.1016/j.chpulm.2024.100050","url":null,"abstract":"<div><h3>Background</h3><p>Lung nodule incidence is increasing. Many nodules require biopsy to discriminate between benign and malignant causes. The gold standard for minimally invasive biopsy, CT scan-guided transthoracic needle biopsy (CT-TTNB), has not been compared directly with navigational bronchoscopy, a method that recently has seen rapid technological innovation and is associated with improving diagnostic yield and lower complication rates. Current estimates of the diagnostic usefulness of both methods are based largely on noncomparative data with significant risk for selection, referral, and publication biases.</p></div><div><h3>Research Question</h3><p>Is contemporary navigational bronchoscopy noninferior to CT scan-guided transthoracic needle biopsy for the diagnosis of indeterminate pulmonary nodules?</p></div><div><h3>Study Design and Methods</h3><p>Navigation Endoscopy to Reach Indeterminate Lung Nodules vs Transthoracic Needle Aspiration, a Randomized Controlled Study, is a multicenter, 1:1 randomized, parallel-group trial designed to ascertain whether electromagnetic navigational bronchoscopy with integrated digital tomosynthesis is noninferior to CT-TTNB for the diagnosis of peripheral lung nodules 10 to 30 mm in diameter with before testing probability of malignancy of at least 10%. The primary end point is diagnostic accuracy through 12 months of follow-up. Secondary end points include diagnostic yield, complication rate, procedure duration, need for additional invasive diagnostic procedures, and radiation exposure.</p></div><div><h3>Results</h3><p>This article describes the protocol and rationale for the Navigation Endoscopy to Reach Indeterminate Lung Nodules vs Transthoracic Needle Aspiration, a Randomized Controlled Study, designed to answer the study question.</p></div><div><h3>Interpretation</h3><p>The results of this rigorously designed trial will provide high-quality data regarding the management of lung nodules, a common clinical entity that often represents the earliest and most treatable stage of lung cancer. Several design challenges are described. Notably, all nodules are reviewed centrally by an independent interventional pulmonology and radiology adjudication panel relying on prespecified exclusions to ensure enrolled nodules are amenable to sampling by both methods while protecting against selection bias favoring either method. Conservative diagnostic yield and accuracy definitions with prespecified criteria for what nonmalignant findings may be considered diagnostic were chosen to avoid inflation of estimates of diagnostic usefulness.</p></div><div><h3>Trial Registry</h3><p><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: NCT04250194; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 3","pages":"Article 100050"},"PeriodicalIF":0.0,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000163/pdfft?md5=7c32c0e35ce0f18c518df629e6ef3dc6&pid=1-s2.0-S2949789224000163-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141736704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maximizing Lung Cancer Screening Uptake","authors":"John Michael Sweetnam MD ,&nbsp;Ralph Ward PhD ,&nbsp;Nichole Tanner MD, MSCR","doi":"10.1016/j.chpulm.2023.100030","DOIUrl":"https://doi.org/10.1016/j.chpulm.2023.100030","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 1","pages":"Article 100030"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789223000302/pdfft?md5=f6a33e87e3c80e0ed8bded780e77cda1&pid=1-s2.0-S2949789223000302-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139992438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 74-Year-Old Woman With Dyspnea, Diffuse Bilateral Thickened Bronchovascular Bundle, Multiple Small Nodules, and a Thin-Walled Cavity","authors":"Tomoya Maruyama MD ,&nbsp;Takashi Nishida MD ,&nbsp;Takashi Ishiguro MD ,&nbsp;Tetsu Kanauchi MD ,&nbsp;Yoshihiko Shimizu MD ,&nbsp;Noboru Takayanagi MD","doi":"10.1016/j.chpulm.2023.100028","DOIUrl":"10.1016/j.chpulm.2023.100028","url":null,"abstract":"<div><h3>Case Presentation</h3><p>A 74-year-old Japanese woman sought treatment at the hospital for gradually progressive dyspnea and fatigue of 7 months’ duration and bilateral abnormalities on chest radiography. Past medical history was insignificant, and she had not begun any new medications for several years. She had no history of tobacco use, alcohol use, or exposure to chemicals or various dusts.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 1","pages":"Article 100028"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789223000284/pdfft?md5=a68c355dc526ebbca22458ed7f1c7a4f&pid=1-s2.0-S2949789223000284-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135515405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 20-Year-Old Man With Disproportionate Chest Radiograph Abnormality","authors":"Utkarsh Gupta MD ,&nbsp;Mahismita Patro DM ,&nbsp;Dipti Gothi MD","doi":"10.1016/j.chpulm.2024.100038","DOIUrl":"10.1016/j.chpulm.2024.100038","url":null,"abstract":"<div><h3>Case Presentation</h3><p>A 20-year-old man presented to the pulmonology outpatient clinic with gradually progressive exertional dyspnea for 2 years. He denied history of fever, cough, wheezing, chest tightness, weight loss, or hemoptysis. He had no history of tobacco use and worked as a clerk at the airport. There was no occupational or environmental exposure. He had no medical or pulmonary or cardiac history. His family history was noncontributory.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 1","pages":"Article 100038"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000047/pdfft?md5=acffbb20d1adc7552abedf63555daa54&pid=1-s2.0-S2949789224000047-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139880279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IL-6 Levels in Acute Respiratory Failure Secondary to Non-COVID-19 Viral Infection","authors":"Matthew J. Fisher MD","doi":"10.1016/j.chpulm.2024.100035","DOIUrl":"10.1016/j.chpulm.2024.100035","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 1","pages":"Article 100035"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000011/pdfft?md5=f5461a09b51ced01a8d3558ca1977fdf&pid=1-s2.0-S2949789224000011-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139632407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perception, Challenges, and Barriers of Point-of-Care Lung Ultrasound Among Respiratory Therapist in the United States","authors":"Kristin Ireland MSRC, RRT ,&nbsp;Noha Daher DrPh ,&nbsp;Michael Terry BS, RRT, RPFT ,&nbsp;David López EdD, RRT ,&nbsp;Paul Casillas MSRC, RRT-ACCS ,&nbsp;Laren D. Tan MD, MPH, FCCP ,&nbsp;Abdullah Alismail PhD, RRT, FCCP, FAARC","doi":"10.1016/j.chpulm.2023.100029","DOIUrl":"10.1016/j.chpulm.2023.100029","url":null,"abstract":"<div><h3>Background</h3><p>Point-of-care lung ultrasound (POCLUS) has gained significant interest within the respiratory therapy profession.</p></div><div><h3>Research Question</h3><p>Does participating in an online on-demand POCLUS didactic course affect the willingness to use or promote POCLUS among respiratory therapists (RTs)? What are the critical barriers to the implementation of POCLUS? What are the perceptions of RTs about the use of POCLUS?</p></div><div><h3>Study Design and Methods</h3><p>This study used a pre-educational vs posteducational interventional design and received approval from the institutional review board. Participants were recruited via social media channels. The inclusion criteria required participants to be licensed registered RTs actively engaged in bedside practice within the United States. After signing the informed consent form, participants completed an online survey, underwent the online course, and participated in a 2-week follow-up survey.</p></div><div><h3>Results</h3><p>A total of 70 participants with a mean ± SD age of 38.8 ± 9.0 years participated in the study. Most participants were female (n = 50 [71.4%]) and had been practicing as RTs for &gt; 1 year (n = 65 [92.9%]). Most participants (87.1% [n = 61]) had observed POCLUS being performed on a patient and were curious to use it after the course; 97.1% (n = 68) believed that POCLUS should be incorporated into the clinical assessment. Additionally, 91.4% (n = 64) of the participants discussed the POCLUS elements with fellow RTs and 90% (n = 63) reported an increased willingness to use this skill. The top barriers to performing POCLUS were the lack of a formal curriculum and limited device availability. Interestingly, financial incentives did not emerge as a significant barrier.</p></div><div><h3>Interpretation</h3><p>Our findings show that RTs display strong willingness and interest in integrating POCLUS into their daily clinical assessments. The inclusion of POCLUS in the curriculum was found to be the primary barrier, whereas financial incentives were not reported as a significant barrier.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 1","pages":"Article 100029"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789223000296/pdfft?md5=4a08a14e788b457ee9790d9ba2ee6778&pid=1-s2.0-S2949789223000296-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135509957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Lung Cancer Prediction Model “Stress Test”","authors":"Brent E. Heideman MD ,&nbsp;Michael N. Kammer PhD ,&nbsp;Rafael Paez MD ,&nbsp;Terra Swanson MD ,&nbsp;Caroline M. Godfrey MD ,&nbsp;See-Wei Low MD ,&nbsp;David Xiao MD ,&nbsp;Thomas Z. Li BS ,&nbsp;Jacob R. Richardson BS ,&nbsp;Michael A. Knight BS ,&nbsp;Samira Shojaee MD ,&nbsp;Stephen A. Deppen PhD ,&nbsp;Robert J. Lentz MD ,&nbsp;Eric L. Grogan MD, MPH ,&nbsp;Fabien Maldonado MD, FCCP","doi":"10.1016/j.chpulm.2023.100033","DOIUrl":"https://doi.org/10.1016/j.chpulm.2023.100033","url":null,"abstract":"<div><h3>Background</h3><p>Pulmonary nodules represent a growing health care burden because of delayed diagnosis of malignant lesions and overtesting for benign processes. Clinical prediction models were developed to inform physician assessment of pretest probability of nodule malignancy but have not been validated in a high-risk cohort of nodules for which biopsy was ultimately performed.</p></div><div><h3>Research Question</h3><p>Do guideline-recommended prediction models sufficiently discriminate between benign and malignant nodules when applied to cases referred for biopsy by navigational bronchoscopy?</p></div><div><h3>Study Design and Methods</h3><p>We assembled a prospective cohort of 322 indeterminate pulmonary nodules in 282 patients referred to a tertiary medical center for diagnostic navigational bronchoscopy between 2017 and 2019. We calculated the probability of malignancy for each nodule using the Brock model, Mayo Clinic model, and Veterans Affairs (VA) model. On a subset of 168 patients who also had PET-CT scans before biopsy, we also calculated the probability of malignancy using the Herder model. The performance of the models was evaluated by calculating the area under the receiver operating characteristic curves (AUCs) for each model.</p></div><div><h3>Results</h3><p>The study cohort contained 185 malignant and 137 benign nodules (57% prevalence of malignancy). The malignant and benign cohorts were similar in terms of size, with a median longest diameter for benign and malignant nodules of 15 and 16 mm, respectively. The Brock model, Mayo Clinic model, and VA model showed similar performance in the entire cohort (Brock AUC, 0.70; 95% CI, 0.64-0.76; Mayo Clinic AUC, 0.70; 95% CI, 0.64-0.76; VA AUC, 0.67; 95% CI, 0.62-0.74). For 168 nodules with available PET-CT scans, the Herder model had an AUC of 0.77 (95% CI, 0.68-0.85).</p></div><div><h3>Interpretation</h3><p>Currently available clinical models provide insufficient discrimination between benign and malignant nodules in the common clinical scenario in which a patient is being referred for biopsy, especially when PET-CT scan information is not available.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 1","pages":"Article 100033"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789223000338/pdfft?md5=ab81a899ad0ff8f761d29d25d886c6b9&pid=1-s2.0-S2949789223000338-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140112665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of High-Frequency Chest Wall Oscillation on Health Care Resource Use and Economic Outcomes in Adult Patients With Non-Cystic Fibrosis Bronchiectasis in the United States","authors":"Martha E. Camacho Urribarri RN, BSN,&nbsp;Brian C. Becker MEd RRT,&nbsp;Angela C. Murray MNA, BScN, RN","doi":"10.1016/j.chpulm.2023.100013","DOIUrl":"10.1016/j.chpulm.2023.100013","url":null,"abstract":"<div><h3>Background</h3><p>Airway clearance therapy is prescribed to patients with bronchiectasis, but limited evidence exists demonstrating the effectiveness of medical device treatment options.</p></div><div><h3>Research Question</h3><p>What is the impact of high-frequency chest wall oscillation therapy (HFCWO) on health care resource use (HCRU) and economic outcomes in patients with bronchiectasis in the United States?</p></div><div><h3>Study Design and Methods</h3><p>A retrospective pre-post cohort study was conducted using the PharMetrics Health Plan Claims Database. The study included commercially insured adult patients with bronchiectasis receiving HFCWO between January 2009 and February 2018. Health care claims were compared 12 months before and after initiation of HFCWO. End points included all-cause and disease-specific HCRU and costs. Comparisons were conducted using McNemar’s test for categorical variables and the Wilcoxon signed-rank test for continuous variables.</p></div><div><h3>Results</h3><p>A total of 255 patients were included. Mean age was 55.6 years, and 58% were high risk. Compared with baseline, significant reductions in all-cause hospital length of stay (9 vs 6 days; <em>P</em> = .05), oral antibiotics (89% vs 80%; <em>P</em> = .002), IV antibiotics (12% vs 6%; <em>P</em> = .01), and radiology examinations (96% vs 92%; <em>P</em> = .03) were observed. For disease-specific outcomes, significant reductions in hospitalizations (8% vs 3%; <em>P</em> = .004), acute exacerbations (7% vs 2%; <em>P</em> = .007), outpatient physician office visits (87% vs 78%; <em>P</em> &lt; .001), radiology examinations (58% vs 34%; <em>P</em> &lt; .0001), and laboratory services (51% vs 38%; <em>P</em> = .001) were found. Significant reductions in disease-specific costs were identified, including inpatient hospitalizations, pulmonologist visits, and radiology examinations; however, despite these reductions, all-cause total cost data were similar for both periods because of the cost of the device.</p></div><div><h3>Interpretation</h3><p>HFCWO therapy is associated with lower HCRU 12 months after initiation of therapy. Further health economic studies are required to determine if cost savings offset cost of the device after 1 year.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 1","pages":"Article 100013"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789223000132/pdfft?md5=3f04f8259c0dba311e3480e1933e9e1c&pid=1-s2.0-S2949789223000132-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91516592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-Acting Beta-Agonists, Antibiotics, Oral Corticosteroids, and the Associated Burden of COPD","authors":"","doi":"10.1016/j.chpulm.2024.100042","DOIUrl":"10.1016/j.chpulm.2024.100042","url":null,"abstract":"<div><h3>Background</h3><p>Severe acute exacerbations of COPD (AECOPDs) are key events that drive health care resource use (HCRU) and negatively impact patients’ quality of life.</p></div><div><h3>Research Question</h3><p>What is the real-world burden of COPD relative to patients’ medication history, specifically, exposure to short-acting beta-agonists (SABAs), antibiotics, and oral corticosteroids (OCSs)?</p></div><div><h3>Study Design and Methods</h3><p>A population-based retrospective cohort study was conducted of patients in Alberta, Canada, identified as having COPD based on administrative health care data (April 1, 2011-March 31, 2019). The risk of severe AECOPDs over 90 days (COPD events resulting in hospitalization or ED visits) and COPD-specific HCRU were studied relative to prior-year SABA, antibiotic, and OCS history.</p></div><div><h3>Results</h3><p>One hundred eighty-eight thousand nine hundred sixty-nine patients identified with COPD were identified (mean ± SD age, 68.8 ± 13.0 years). After controlling for age, sex, calendar year at index, comorbidities at index, and prior severe AECOPDs, patients with frequent SABA, antibiotic, or OCS exposure in a given year showed significantly higher 90-day risks of severe AECOPDs in a positively associated relationship. Patients with the highest SABA exposure (≥ 6 canisters in a given year) showed twice the rate of severe AECOPDs as patients with 1 SABA canister (incidence rate ratio [IRR], 2.06; 95% CI, 2.01-2.11). The 90-day rates of severe AECOPDs were 51% higher for patients with ≥ 6 vs 1 to 2 antibiotic dispensations (IRR, 1.51; 95% CI, 1.48-1.55) and 3% higher for patients with ≥ 6 vs 1 to 5 OCS burst days (IRR, 1.03; 95% CI, 1.00-1.06). Mean annualized rates of hospitalization and ED visits were highest for patients dispensed ≥ 6 (vs fewer) SABA canisters or antibiotics and patients with any OCS burst days in a given year.</p></div><div><h3>Interpretation</h3><p>Histories of frequent or prolonged exposure to SABAs, antibiotics, or OCSs were associated with higher rates of severe AECOPDs and HCRU.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 3","pages":"Article 100042"},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000084/pdfft?md5=58302ee9be277a2133226f0128477659&pid=1-s2.0-S2949789224000084-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139965801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adaptation of a Tailored Lung Cancer Screening Decision Aid for People With HIV","authors":"","doi":"10.1016/j.chpulm.2024.100044","DOIUrl":"10.1016/j.chpulm.2024.100044","url":null,"abstract":"<div><h3>Background</h3><p>People with HIV are both at elevated risk of lung cancer and at high risk of multimorbidity, which makes shared decision-making (SDM) for lung cancer screening (LCS) in people with HIV complex. Currently no known tools have been adapted for SDM in people with HIV.</p></div><div><h3>Research Question</h3><p>Can an SDM decision aid be adapted to include HIV-specific measures with input from both people with HIV and their providers?</p></div><div><h3>Study Design and Methods</h3><p>This study used qualitative methods including focus groups of people with HIV and interviews with HIV care providers to adapt and iterate an SDM tool for people with HIV. Eligible participants were those with HIV enrolled in an HIV primary care clinic who met age and smoking eligibility criteria for LCS and HIV care providers at the clinic. Both the focus groups and interviews included semistructured discussions of SDM and decision aid elements for people with HIV. We used a framework-guided thematic analysis, mapping themes onto the Health Equity Implementation framework.</p></div><div><h3>Results</h3><p>Forty-three people with HIV participated in eight focus groups; 10 providers were interviewed. Key themes from patients included broad interest in adapting LCS SDM specifically for people with HIV, a preference for clear LCS recommendations, and the need for positive framing emphasizing survival. Providers were enthusiastic about personalized LCS risk assessments and point-of-care tools. Both patients and providers gave mixed views on the usefulness of HIV-specific risk measures in patient-facing tools. Themes were used to adapt a personalized and flexible SDM tool for LCS in people with HIV.</p></div><div><h3>Interpretation</h3><p>People with HIV and providers were enthusiastic about specific tools for SDM that are personalized and tailored for people with HIV, that make recommendations, and that inform LCS decision-making. Divergent views on presenting patient-facing quantitative risk assessments suggests that these elements could be optional but available for review. This tool may have usefulness in complex decision-making for LCS in this population and currently is being evaluated in a pilot prospective trial.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 3","pages":"Article 100044"},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000102/pdfft?md5=a004c19d6177226badc191671f62e881&pid=1-s2.0-S2949789224000102-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139966280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}