Table 5. Communication strategies to improve patient-centred care.

What patients want to know	Clinician communication strategies	Examples
Information
‘What is a nodule’	Provide relevant nodule information that relates to risk prediction (e.g., lack of growth decreases malignancy risk) Review chest imaging Provide written or online information	‘You have a ‘spot’ in the upper part of your right lung- let’s review the chest CT so you see it for yourself’
‘What is my lung cancer risk’	Explain personalised lung cancer risk using decisional aids, data depicted in pictures or summary tables Evaluate patients’ understanding of the concepts presented	‘Because you smoked for 50 years, there is a 5% chance this nodule is cancer. In other words out of 100 people—5 would have cancer.’ Provide link to a nodule risk calculator (e.g., http://reference.medscape.com/calculator/solitary-pulmonary-nodule-risk)
‘What are the next steps/future plan’	Describe the follow-up plan in detail including possible steps if things change (e.g., biopsy for growing nodule) Outline key imaging dates and subsequent office visits or telephone calls and provide a copy Smoking cessation guidance if applicable, framed as a ‘teachable moment’	‘I have ordered a repeat CT scan in 1 year. We will contact you a few days after the CT so we can discuss the results and next steps in management.’ ‘It’s great that your nodule is very unlikely to be lung cancer but now is a good time to quit smoking so your chances of getting cancer in the future will be even lower.’ Provide link/referral to smoking cessation interventions
Emotional response
‘How worried should I be’	Elicit emotional responses to the information presented Provide reassurance and resources to decrease distress Enable the patient with persistent concerns ways to easily contact a clinician	‘What worries you most about this nodule?’ ‘It’s normal to be very distressed when there is even a small possibility of lung cancer.’
Shared decision-making
‘What are my options’	Explain rationale for active surveillance Explain that other options are available but not recommended because the harms usually outweigh the benefits Address that patients often value knowing whether the nodule is cancer and prefer a more immediate answer, however, biopsies and functional imaging seldom provide this answer for small nodules Enable the patient to participate in the decision	‘This nodule is so small and the chance for cancer is so low that the best way to find out what it is- is to wait and get another CT scan. Waiting is the best option right and will not limit your treatment options later.’ ‘We can talk about biopsies and other procedures but in general, they hurt many more people than they help.’ ‘How are you feeling about waiting 6 months for your next CT scan?’

Abbreviation: CT, computed tomography.