Patients' experiences of, and psychological responses to, surveillance for pulmonary nodules detected through lung cancer screening.

Introduction: 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.

Methods: 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.

Results: 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.

Conclusions: 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.