Optimizing Follow-up of Incidental Findings: A Structured Survey of Primary Care Providers
Stephanie D. Talutis1, Ellen Childs2, Philip E. Knapp1, Avneesh Gupta1, Cleopatra Ferrao1, David McAneny1, F. Thurston Drake1 1 Boston University School of Medicine, Boston, MA 2 Boston University School of Public Health, Boston, MA
Background
The study objective is to understand PCP management strategies for incidental pulmonary nodules(PNs) and adrenal nodules(ANs).
Methods
Structured surveys were emailed to PCPs with questions/scenarios about PNs and ANs. To test our hypothesis that easy access to clinical guidelines facilitates appropriate evaluation, half the surveys included society guidelines and half did not.
Results
On average, PCPs encounter 4(SD=6) incidentalomas/month, half from studies ordered by another provider. The most important resources to guide follow-up are radiology report recommendations(PN=80%, AN=74%) and Up-To-Date(PN=59%, AN=65%). While 48% of PCPs had encountered an incidental PN diagnosed as lung cancer, substantially fewer(<10%) had encountered adrenal pathologies among incidental ANs. For PNs, the most significant barrier was insufficient time/support to follow results longitudinally(69%). For ANs, it was uncertainty about tests to order(68%). Themes regarding the "ideal" system: automated report-delivery and follow-up tests, longitudinal tracking tools, "virtual consultations," and EMR-integrated decision guides. Differences between groups with and without guidelines were observed. Access to guidelines was significantly associated with correct choice among lower-risk AN scenarios; there was little impact for higher-risk scenarios (Table).
Conclusions
PCP input is necessary to design an effective system. Easy access to straightforward clinical guidelines may improve decision-making, especially for lower-risk lesions that require action. Radiology reports are the most utilized source of information guiding next steps. Strategies to improve follow-up should include decision guides, tracking capabilities, and EMR-integration. 
Back to 2019 Posters
