BACKGROUND Lung cancer is the leading cause of cancer mortality in Australia. Guidelines suggest that patients with suspected lung cancer on thoracic imaging be referred for urgent specialist review. However, the term "suspected" is broad and includes the common finding of lung nodules, which often require periodic surveillance rather than urgent invasive investigation. The British Thoracic Society recommends that a lung nodule with a PanCan risk > 10% be considered for invasive investigation. This study aimed to assess which factors influence general practitioners (GPs) to request urgent review for a lung nodule and if these factors concur with PanCan risk prediction model variables. METHODS A discrete choice experiment was developed that produced 32 individual case vignettes. Each vignette contained eight variables, four of which form the parsimonious PanCan risk prediction model. Two additional vignettes were created that addressed haemoptysis with a normal chest computed tomography (CT) scan and isolated mediastinal lymphadenopathy. The survey was distributed to 4160 randomly selected Australian GPs and they were asked if the patients in the vignettes required urgent (less than two weeks) specialist review. Multivariate logistic regression identified factors associated with request for urgent review. RESULTS Completed surveys were received from 3.7% of participants, providing 152 surveys (1216 case vignettes) for analysis. The factors associated with request for urgent review were nodule spiculation (adj-OR 5.57, 95% CI 3.88-7.99, p < 0.0001), larger nodule size, presentation with haemoptysis (adj-OR 4.79, 95% CI 3.05-7.52, p < 0.0001) or weight loss (adj-OR 4.87, 95% CI 3.13-7.59, p < 0.0001), recommendation for urgent review by the reporting radiologist (adj-OR 4.68, 95% CI 2.86-7.65, p < 0.0001) and female GP gender (adj-OR 1.87, 95% CI 1.36-2.56, p 0.0001). In low risk lung nodules (PanCan risk < 10%), there was significant variability in perceived sense of urgency. Most GPs (83%) felt that a patient with haemoptysis and a normal chest CT scan did not require urgent specialist review but that a patient with isolated mediastinal lymphadenopathy did (75%). CONCLUSION Future lung cancer investigation pathways may benefit from the addition of a risk prediction model to reduce variations in referral behavior for low risk lung nodules.

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这个肺结节需要紧急检查吗？澳大利亚全科医生的离散选择实验。

背景技术肺癌是澳大利亚癌症死亡的主要原因。指南建议将胸部影像学可疑的肺癌患者转诊至紧急专科医生处。但是，术语“可疑”范围很广，包括常见的肺结节发现，通常需要定期监测而不是紧急的侵入性检查。英国胸科协会建议将PanCan风险> 10％的肺结节考虑用于侵入性检查。这项研究旨在评估哪些因素影响全科医生（GPs）要求紧急检查肺结节，以及这些因素是否与PanCan风险预测模型变量一致。方法开展了一个离散选择实验，该实验产生了32个个案小插曲。每个小插图包含八个变量，其中四个形成了简约的PanCan风险预测模型。创建了两个其他的小插曲，通过正常的胸部计算机断层扫描（CT）扫描和孤立的纵隔淋巴结肿大来解决咯血。该调查被分发给4160个随机选择的澳大利亚全科医生，他们被问及小插曲中的患者是否需要紧急（不到两周）的专家检查。多元逻辑回归确定了与紧急检查请求相关的因素。结果从3.7％的参与者中获得了完整的调查，提供了152个调查（1216个病例）进行分析。与紧急复诊相关的因素有结节性结节（adj-OR 5.57，95％CI 3.88-7.99，p <0.0001），结节较大，出现咯血（adj-OR 4.79，95％CI 3.05-7.52，p <0。0001）或体重减轻（adj-OR 4.87，95％CI 3.13-7.59，p <0.0001），建议报告放射科医生紧急检查（adj-OR 4.68，95％CI 2.86-7.65，p <0.0001）和女性GP性别（adj-OR 1.87，95％CI 1.36-2.56，p 0.0001）。在低风险的肺结节（PanCan风险<10％）中，所感知到的紧迫感存在显着差异。大多数全科医生（83％）认为具有咯血病和胸部CT扫描正常的患者不需要紧急的专家检查，而患有单纯纵隔淋巴结肿大的患者则需要（75％）。结论未来的肺癌研究途径可能会受益于增加风险预测模型，以减少低风险肺结节的转诊行为差异。95％CI 2.86-7.65，p <0.0001）和女性GP性别（adj-OR 1.87，95％CI 1.36-2.56，p 0.0001）。在低风险的肺结节（PanCan风险<10％）中，所感知到的紧迫感存在显着差异。大多数全科医生（83％）认为具有咯血病和胸部CT扫描正常的患者不需要紧急的专家检查，而患有单纯纵隔淋巴结肿大的患者则需要（75％）。结论未来的肺癌研究途径可能会受益于增加风险预测模型以减少低风险肺结节转诊行为的变化。95％CI 2.86-7.65，p <0.0001）和女性GP性别（adj-OR 1.87，95％CI 1.36-2.56，p 0.0001）。在低风险的肺结节（PanCan风险<10％）中，所感知到的紧迫感存在显着差异。大多数全科医生（83％）认为具有咯血病和胸部CT扫描正常的患者不需要紧急的专家检查，而患有单纯纵隔淋巴结肿大的患者则需要（75％）。结论未来的肺癌研究途径可能会受益于增加风险预测模型以减少低风险肺结节转诊行为的变化。大多数全科医生（83％）认为具有咯血病和胸部CT扫描正常的患者不需要紧急的专家检查，而患有单纯纵隔淋巴结肿大的患者则需要（75％）。结论未来的肺癌研究途径可能会受益于增加风险预测模型以减少低风险肺结节转诊行为的变化。大多数全科医生（83％）认为具有咯血病和胸部CT扫描正常的患者不需要紧急的专家检查，而患有单纯纵隔淋巴结肿大的患者则需要（75％）。结论未来的肺癌研究途径可能会受益于增加风险预测模型，以减少低风险肺结节的转诊行为差异。