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

Background: 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. Objectives: To summarize the existing evidence, identify knowledge gaps, and prioritize research questions related to interventions to reduce disparities in lung nodule evaluation. Methods: A multidisciplinary committee was convened to review the evidence and identify key knowledge gaps in four domains: 1 ) research methodology, 2 ) patient-level interventions, 3 ) clinician-level interventions, and 4 ) health system-level interventions. A modified Delphi approach was used to identify research priorities. Results: Key knowledge gaps included 1 ) a lack of standardized approaches to identify factors associated with lung nodule management disparities, 2 ) limited data evaluating the role of social determinants of health on disparities in lung nodule management, 3 ) a lack of certainty regarding the optimal strategy to improve patient-clinician communication and information transmission and/or retention, and 4 ) a paucity of information on the impact of patient navigators and culturally trained multidisciplinary teams. Conclusions: 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: 1 ) need for methodologic guidelines for conducting research related to disparities in nodule management, 2 ) evaluating how social determinants of health influence lung nodule evaluation, 3 ) studying approaches to improve patient-clinician communication, and 4 ) evaluating the utility of patient navigators and culturally enriched multidisciplinary teams to reduce disparities.