Integrating Interstitial Lung Abnormality Detection Into Lung Cancer Screening: A Mixed Methods Approach for Care Pathway Development
Notice bibliographique
Résumé
Abstract Rationale: Interstitial lung abnormalities (ILAs) are incidental parenchymal findings detected on computed tomography scans (CTs). There is a 7% prevalence of ILAs in lung cancer screening (LCS) cohorts, and their presence is associated with increased all-cause mortality. ILAs may progress to clinical fibrotic interstitial lung disease (ILD), however heterogeneity exists therefore there is a need to risk stratify these patients to ensure standardized follow up and efficient use of clinical resources. This study examined current respirology and primary care physician's (PCP) practice patterns and explored the need to develop a care pathway for ILAs detected during LCS. Methods: This mixed-methods study included surveys and structured interviews with respirologists and PCPs in Alberta, Canada. Online surveys were distributed via email invitation to all licensed respirologists within the province, as well as primary care networks, and participants volunteered for one-on-one interviews. Interviews were conducted using the Theoretical Domains Framework and Consolidated Framework for Implementation Research. Survey results are presented with descriptive frequencies. Qualitative data were transcribed, coded and analyzed according to grounded theory principle. Results: Respirologists: A response rate of 33% (n=39/117) was achieved (Table 1). Respirologists reported feeling comfortable managing ILA, but most (64%) did not follow a standardized approach. Pulmonary function tests (PFTs) were recommended by 67% of respondents, and 36% recommended a high-resolution CT. The majority (69%) believed ILAs should be followed for at least 3 years, while 15% only followed patients if ILD was present (symptoms, abnormal PFTs). Key themes from 11 interviews included knowledge, risk stratification, and suggestions for care pathway standardization. PCP: 17 participated in the online survey and 7 participated in interviews. The majority (59%) were not familiar with the term ILA and 100% of respondents thought there should be a standardized care pathway (Table 1). Key interview themes included radiology report guidance, personal referral practices and resource limitations. Conclusions: Respirologists frequently manage patients with ILAs, but their approaches vary. Most patients are followed longitudinally, which requires healthcare resources, including consultation, lung function and imaging. PCP were unfamiliar with the term ILA, and would value a standardized care pathway for this patient population. With the establishment of LCS programs, a large number of patients with ILAs will be detected. Our findings highlight the need for targeted health care resources to manage this patient population and proposes respirologist and PCP-informed recommendations for implementing a standardized care pathway.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,136 | 0,095 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,002 |
| Méta-épidémiologie (sens large) | 0,002 | 0,003 |
| Bibliométrie | 0,009 | 0,006 |
| Études des sciences et des technologies | 0,006 | 0,003 |
| Communication savante | 0,009 | 0,005 |
| Science ouverte | 0,006 | 0,011 |
| Intégrité de la recherche | 0,002 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».