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Education Level Predicts Appropriate Follow-Up of Incidental Findings From Lung Cancer Screening

Suraj Kapoor
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Suraj Kapoor
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Affiliations

  • Vanderbilt University School of Medicine, Nashville, Tennessee
, BSa
,
Stephen A. Deppen
x
Stephen A. Deppen
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Affiliations

  • Division of Epidemiology, Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
  • Tennessee Valley Healthcare System, Veterans Affairs, Nashville, Tennessee

Correspondence

  • Corresponding author and reprints: Stephen A. Deppen, PhD, Department of Thoracic Surgery, Vanderbilt University Medical Center, 609 Oxford House, Nashville, TN 37232.
, PhDb,c,∗,'Correspondence information about the author PhD Stephen A. Deppen
x
Stephen A. Deppen
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Affiliations

  • Division of Epidemiology, Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
  • Tennessee Valley Healthcare System, Veterans Affairs, Nashville, Tennessee

Correspondence

  • Corresponding author and reprints: Stephen A. Deppen, PhD, Department of Thoracic Surgery, Vanderbilt University Medical Center, 609 Oxford House, Nashville, TN 37232.
,
Alexis B. Paulson
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Alexis B. Paulson
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Affiliations

  • Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
, MSN, APRN, WHNP-BCd
,
Diane Haddad
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Diane Haddad
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Affiliations

  • Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
, MDe
,
James P. Cook
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James P. Cook
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Affiliations

  • Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
, MDd
,
Kim L. Sandler
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Kim L. Sandler
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Affiliations

  • Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
, MDd
Education Level Predicts Appropriate Follow-Up of Incidental Findings From Lung Cancer Screening
DOI: https://doi.org/10.1016/j.jacr.2019.12.014

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Abstract

Purpose

The aim of this study was to identify predictors of appropriate follow-up for clinically significant incidental findings (IFs) detected with low-dose CT during lung cancer screening.

Methods

Charts of 1,458 prospectively enrolled lung screening patients from January 1, 2015, to October 31, 2018, were reviewed. IFs, other than coronary artery calcification and emphysema, were identified. ACR practice guidelines defined appropriate patient follow-up. Patient demographic and social characteristics were obtained from the initial shared decision-making visit and the electronic medical record. Factors of interest included age, gender, race, education level, and insurance status. Education level was reported as high school graduate or less or education past high school. A multivariate logistic regression was estimated to assess patient factors associated with appropriate follow-up.

Results

One hundred thirty-eight participants (9%) with 141 actionable IFs were identified. The overall appropriate follow-up rate was 82%. The most common IFs were renal lesions (16%), dilated thoracic aorta (10%), and pulmonary fibrosis (10%). Univariate analysis of appropriate patient follow-up revealed a significant difference for education level (P = .02). A greater than high school education remained strongly associated with appropriate follow-up after controlling for other demographic factors.

Conclusions

Appropriate patient follow-up of clinically significant IFs from lung cancer screening is a well-recognized avenue to improve population health. Education level is a significant independent predictor of appropriate follow-up of IFs, whether as a surrogate for low socioeconomic status or as an indication of health literacy. To address these realities, lung screening shared decision making should adapt to consider health care access and health literacy.

Key Words:

Lung cancer screening, incidental findings, education, health literacy

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This research was funded by the Vanderbilt University School of Medicine Research Immersion Program. The authors state that they have no conflict of interest related to the material discussed in this article.

© 2019 Published by Elsevier on behalf of American College of Radiology
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