Contemporary Pulmonary Nodule Evaluation and Management in the United States A Mixed-Methods Study
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Effective evaluation and management of pulmonary nodules (PNs) are essential to diagnosing early-stage lung cancers while avoiding unnecessary invasive procedures. There are key knowledge gaps in how clinicians manage PNs and which opportunities for improvement should be prioritized. RESEARCH QUESTION: Which factors contribute to clinicians' PN evaluation and management practices, and what are perceived barriers to optimal clinical care? STUDY DESIGN AND METHODS: From August 2024 to December 2025, an exploratory sequential mixed-methods study of clinicians who care for patients with PNs was performed. First, we conducted semi-structured qualitative interviews with 40 clinicians across multiple specialties prior to thematically analyzing interview transcripts to develop and administer a quantitative online survey nationwide. We descriptively analyzed survey data, triangulated results with representative interview quotes, and performed exploratory analyses assessing factors associated with survey responses selected by a priori study objectives and qualitative findings. RESULTS: Of 3,588 US clinicians invited via email to participate in the survey, 192 (5.4%) across general pulmonology, interventional pulmonology, thoracic surgery, and other specialties completed it. Most clinicians (70.8%) reported using risk assessment tools to evaluate PN cancer risk, with clinical risk prediction models (70.3%) more commonly used than commercial biomarkers (18.8%). Most participants (63.5%) believed that an ideal risk assessment tool should prioritize not missing a lung cancer diagnosis rather than avoiding unnecessary invasive procedures. Clinicians generally agreed that PN evaluation is challenging (71.4%) and requires shared decision-making (95.8%), multidisciplinary collaboration (91.1%), and improvement (85.9%). Only 50.5% reported having the clinical resources necessary to provide optimal PN care. Participants ranked PN tracking and risk assessment tools as the top priorities for improving PN clinical care. INTERPRETATION: Our results show that clinicians find PN evaluation challenging, requiring multidisciplinary collaboration, shared decision-making, and improvement, but many lack adequate resources to provide optimal care. Future efforts should focus on improving system-level PN tracking and cancer risk assessment.
Source: CHEST Journal
Institutions: Abramson Cancer Center, University of Pennsylvania
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,160
OpenAlex ID: W7171546922