Research Priorities for Interventions to Address Health Disparities in Lung Nodule Management: An Official American Thoracic Society Research Statement.

Abstract

<b>Background:</b> Lung nodules are common incidental findings, and timely evaluation is critical to ensure diagnosis of localized-stage and potentially curable lung cancers. Rates of guideline-concordant lung nodule evaluation are low, and the risk of delayed evaluation is higher for minoritized groups. <b>Objectives:</b> To summarize the existing evidence, identify knowledge gaps, and prioritize research questions related to interventions to reduce disparities in lung nodule evaluation. <b>Methods:</b> A multidisciplinary committee was convened to review the evidence and identify key knowledge gaps in four domains: <i>1</i>) research methodology, <i>2</i>) patient-level interventions, <i>3</i>) clinician-level interventions, and <i>4</i>) health system-level interventions. A modified Delphi approach was used to identify research priorities. <b>Results:</b> Key knowledge gaps included <i>1</i>) a lack of standardized approaches to identify factors associated with lung nodule management disparities, <i>2</i>) limited data evaluating the role of social determinants of health on disparities in lung nodule management, <i>3</i>) a lack of certainty regarding the optimal strategy to improve patient-clinician communication and information transmission and/or retention, and <i>4</i>) a paucity of information on the impact of patient navigators and culturally trained multidisciplinary teams. <b>Conclusions:</b> This statement outlines a research agenda intended to stimulate high-impact studies of interventions to mitigate disparities in lung nodule evaluation. Research questions were prioritized around the following domains: <i>1</i>) need for methodologic guidelines for conducting research related to disparities in nodule management, <i>2</i>) evaluating how social determinants of health influence lung nodule evaluation, <i>3</i>) studying approaches to improve patient-clinician communication, and <i>4</i>) evaluating the utility of patient navigators and culturally enriched multidisciplinary teams to reduce disparities.