RESUMO

BACKGROUND: One challenge in high-quality lung cancer screening (LCS) is maintaining adherence with annual and short-interval follow-up screens among high-risk individuals who have undergone baseline low-dose CT (LDCT). This study aimed to characterize attitudes and beliefs toward lung cancer and LCS and to identify factors associated with LCS adherence. METHODS: We administered a questionnaire to 269 LCS participants to assess attitudes and beliefs toward lung cancer and LCS. Clinical data including sociodemographics and screening adherence were obtained from the LCS Program Registry. RESULTS: African-American individuals had significantly greater lung cancer worries compared with Whites (6.10 vs. 4.66, P < .001). In making the decision to undergo LCS, African-American participants described screening convenience and cost as very important factors significantly more frequently than Whites (60% vs. 26.8%, P< .001 and 58.4% vs. 37.8%, P = .001; respectively). African-American individuals with greater than high school education had significantly higher odds of LCS adherence (aOR 2.55; 95% CI, 1.14-5.60) than Whites with less than high school education. Participants who described screening convenience and cost as "very important" had significantly lower odds of completing screening follow-up after adjusting for demographic and other factors (aOR 0.56; 95% CI, 0.33-0.97 and aOR 0.54; 95% CI, 0.33-0.91, respectively). CONCLUSION: Racial differences in beliefs about lung cancer and LCS exist among African-American and White individuals enrolled in an LCS program. Cost, convenience, and low educational attainment may be barriers to LCS adherence, specifically among African-American individuals. IMPACT: More research is needed on how barriers can be overcome to improve LCS adherence.

Assuntos

Detecção Precoce de Câncer , Disparidades em Assistência à Saúde , Neoplasias Pulmonares/diagnóstico , Programas de Rastreamento , Fatores Raciais , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Inquéritos e Questionários

RESUMO

Audience: Emergency medicine residents (interns, junior residents), medical students, and mid-level providers (physician assistants, nurse practitioners). Introduction: Pneumothorax refers to the presence of gas within the pleural space and is a relatively common clinical entity in the emergency department.1 Traumatic pneumothorax results from blunt or penetrating trauma to the thorax. Iatrogenic pneumothorax is a risk inherent to a number of invasive procedures and represents a significant cause of preventable morbidity.2 Specifically, central venous catheterization (43.8%), thoracentesis (20.1%), and barotrauma due to mechanical ventilation (9.1%) are the most frequent causes.3A feared complication of pneumothorax is the development of tension pneumothorax, which involves the compression of mediastinal structures by increased pressures within the pleural space, leading to hemodynamic compromise.4 As tension pneumothorax is an emergent, life-threatening condition, the management of pneumothorax and the insertion of chest tubes are skills required of physicians involved in the care of injured patients, including general surgeons, intensivists, and emergency medicine physicians.5 The process of correcting pneumothorax is not without complication. Complications following chest tube insertion in trauma patients occur in 19% of cases,6 and are commonly a result of chest tubes placed by resident physicians.7The authors believe that a web-based learning module addressing topics related to pneumothorax (pathophysiology, clinical manifestations, diagnosis, and management) would be beneficial to healthcare providers who are likely to encounter pneumothorax in clinical practice. Specifically, the web-based nature of the module would lend itself to convenient viewing and would allow for utilization as a just-in-time training modality. Presenting these topics in an animated format may also be a useful way of capturing the complex and three-dimensional nature of respiratory physiology. Additionally, the web-based format may be particularly appealing to digital native natives, who occupy an increasing percentage of resident physician positions.8 It should be noted that a number of studies have examined the use of computerized modules in medical education, and found them to be at least as useful as traditional instructional methods, and are typically associated with high rates of satisfaction among learners.9-13. Educational Objectives: By the end of this module, participants should be able to:Review the normal physiology of the pleural spaceDiscuss the pathophysiology of pneumothoraxDescribe the clinical presentation of pneumothoraxIdentify pneumothorax on a chest radiographReview treatment options for pneumothorax. Educational Methods: This is a video podcast, which conveys information through animated content. It is available to learners on demand and just-in-time for practice. It may be used as a stand-alone educational tool, as a primer to other instructional methods (eg, simulation), or a just-in-time training tool. Research Methods: A small-scale study was conducted to evaluate the efficacy of this module as an educational tool. The learner group consisted of a convenience sample of 11 second-year medical students at the end of their pre-clinical training. All learners were administered the attached assessment form as a pre-test, shown the video, then asked to re-take the assessment as a post-test to assess improvement. Assessments were graded on a 10-point scale according to the attached answer key. Learners were also given the opportunity to rate the quality of the module as an educational tool, as well as to provide subjective feedback. Results: The average pre-test score across all learners was 34%. The average post-test score across all learners was 82%, representing an improvement of 48%. Learners were asked to rate their agreement with the statements, "This module effectively taught concepts related to pulmonary physiology and pneumothorax," and, "The animated format of this module was useful for illustrating concepts related to pulmonary physiology and pneumothorax." All learners responded with "agree" or "strongly agree" for each statement. When given the opportunity to provide subjective feedback regarding the module, learners responded with "This module is a great review! It is well organized, has effective animations, and information is clear," and "Helpful review that explained the concepts in an accessible way!" Discussion: Results from the pre-test and post-test suggest that this module was effective in teaching concepts related to pulmonary physiology and pneumothorax. All learners reported satisfaction with the animated format in particular. These results suggest that this module would be effective as a standalone educational tool or as a primer to other instructional methods. Topics: Pneumothorax, thoracostomy, needle decompression, flipped classroom, asynchronous learning, emergency medicine.