Table 2.
Summary of Derivatives
| Description | How/Why? | Development Resources | Validation/Evaluation | How/Where? |
|---|---|---|---|---|
| Cross-cutting derivatives | ||||
| Nodule registries: EMR-based radiology reports with links to patient-level administrative data for identification and description of lung nodules on chest imaging | Development of clinically useful EMR-based registries, potentially aided by natural language processing, will facilitate ongoing research and quality improvement initiatives | ATS (BSHSR, Clinical Problems, nursing, TOA) | Multicenter adoption and tracking of subsequent management | Make available on ATS (and other) websites once validated |
| Identifying patients with nodules and associated clinical and radiological characteristics is currently very expensive or impractical | Other professional societies | Compare to prior management | Cooperate with providers of reporting systems or EMR to incorporate | |
| Could reduce variability in practice | Consensus statement on reporting elements, incorporation into reporting systems/EMR | Partner with other stakeholders such as the American College of Radiology, ACCP, Society of Thoracic Surgeons, American Society for Radiation Oncology, American College of Physicians | ||
| Could inform clinicians about appropriate management | ||||
| Consortiums to pool clinical data and specimens for biomarker development and validation in screening centers | Could provide diverse, unbiased approach to validate biomarkers and strategies to implement biomarkers | ATS (TOA, RCMB, Clinical Problems) | Patient testing | Potential partners include ATS, DOD/VA, foundations, IASLC, NCI and CRN, NIH-NHLBI |
| Could guide use of biomarkers, refine diagnostic approach to lung nodules | Grants: NCI | Lab testing | ||
| Healthcare systems | Clinician testing | |||
| Payers | ||||
| Policy makers | ||||
| Development of a framework and consensus manual on added value of new technologies for the evaluation of pulmonary nodules | Could provide minimal requirements or gold standards for the level of evidence of the study itself, mathematical evaluation of added value, balance of gain in diagnostic accuracy vs. additional efforts and costs of the new technology. Could improve translation of research outcomes to clinical practice and to educate clinicians | Consensus statement developed by working group connected to association (researchers, clinicians, patients, systems, payers, grant funders) | Multicenter adoption and tracking of subsequent management | Connect to ATS/ACCP to form working group of interested experts |
| Pragmatic trials | Review of literature and consensus meetings | |||
| Comparative effectiveness research methodologies | ||||
| Diagnostic imaging and invasive procedures | ||||
| Evidence-based, easily electronically accessed (web, mobile applications) user (clinician and patient)-friendly lung cancer risk stratification tools for pulmonary nodules. Could include unbiased information on lung cancer risk stratification, commercially available diagnostic tests, and listings of clinical expertise based on availability of technologies and nodule clinics | Could improve risk estimation by clinicians. Could provide tailored information for patients. Could improve information dissemination, regionalization, decision-making, and resource use | ATS (BSHSR, Clinical Problems, nursing, TOA) | Patient testing | Conference |
| Other professional societies | Lab testing | Peer-reviewed journal | ||
| Healthcare systems | Clinician testing | Research study | ||
| Payers | Feedback section on website | ATS website | ||
| Policy makers | Website developer, content development, connection to an association (e.g., ATS, ACCP, patient advocacy group) | |||
| Biomarkers | ||||
| Incorporation of data elements regarding small specimen acquisition and processing into a voluntary registry that acquires quality and performance data from interventional pulmonary procedures | Could provide education to interventional pulmonary programs. Could enhance standardization of protocols and innovation to improve performance | ATS/ACCP | Patient testing | Conference |
| Grants | Lab testing | Peer-reviewed journal | ||
| Healthcare systems | Clinician testing | Research study | ||
| Payers | ||||
| Policy makers | ||||
| Implementation | ||||
| Development of evidence-based performance measures and quality metrics | Could improve quality and adherence to guidelines. Could facilitate reporting of nodule and patient characteristics | Healthcare systems | Stakeholder consensus | Output from stakeholder conference |
| Patient stakeholder groups | ||||
| Payers | ||||
| Policy makers | ||||
| Professional societies | ||||
| Patient-centered outcomes | ||||
| Multi-stakeholder consensus group whose purpose is to use formal methods to elicit unmet patient needs, prioritize a research agenda, identify concerns, and offer potential solutions | Uses formal methods to obtain consensus from multiple stakeholders. Sets a research agenda based on needs identified as most important to patients, with input from multiple stakeholders | ATS (BSHSR, Clinical Problems, nursing, TOA, PAR) | Elicit feedback from others not involved in group but pulled from same stakeholder groups to ensure face validity | Conference |
| Healthcare systems | Potential funding from NCI, PCORI, professional societies, and healthcare systems | |||
| Other professional societies | ||||
| Patients | ||||
| Patient advocacy organizations | ||||
| Payers | ||||
| Policy makers | ||||
| Instruments that measure decision quality specific to issues surrounding lung cancer screening and nodule evaluation | Context-specific instruments better able to measure decision quality than generic instruments. Could help measure effect of decision support tools | ATS (BSHSR, Clinical Problems, nursing, TOA) | Patient testing | Conference |
| Grants | Peer-reviewed journal | |||
| Healthcare systems | Research study | |||
| Payers | ||||
| Policy makers | ||||
| Individually tailored patient- and clinician-accessible communication aids, including decision support tools and educational materials that address key patient questions and improve satisfaction with decision-making | Could improve patient–clinician communication processes. Could allow patients to weigh options based on their own preferences and values. Could facilitate shared decision-making | ATS (BSHSR, Clinical Problems, SOTO, PAR) | Patient testing | Conference |
| Grants | Clinician testing | ATS website | ||
| Healthcare systems | Lab testing/role play/simulated clinic visits | |||
| Payers | Actual recorded clinic visits | |||
| Policy makers | ||||
Definition of abbreviations: ACCP = American College of Chest Physicians; ATS = American Thoracic Society; BSHSR = Behavioral Science and Health Services Research; CRN = Cancer Research Network; DOD = Department of Defense; EMR = electronic medical record; IASLC = International Association for the Study of Lung Cancer; NCI = National Cancer Institute; NIH = National Institutes of Health; PAR = Public Advisory Roundtable; PCORI = Patent-Centered Outcomes Research Institute; RCMB = Respiratory Cell and Molecular Biology; SOTO = Section on Thoracic Oncology; TOA = Thoracic Oncology Assembly; VA = Veterans Affairs.