Integrating interstitial lung abnormality detection into lung cancer screening: a mixed methods approach for care pathway development

Rationale Interstitial lung abnormalities (ILAs) are incidental parenchymal findings detected on CT scans. There is an estimated 4%–17% prevalence of ILAs in lung cancer screening (LCS) cohorts, associated with increased all-cause mortality. A substantial proportion of fibrotic ILAs progresses to interstitial lung disease (ILD), offering an important opportunity for early identification and management of ILD. However, current reporting and management strategies for ILAs are heterogeneous, underscoring the need for standardised approaches. Objective To explore current practice patterns among primary care physicians (PCPs), respirologists and radiologists and to assess the need for a standardised care pathway for ILAs identified through LCS programmes. Methods Online surveys and one-on-one semistructured interviews were conducted with PCPs, respirologists and radiologists practising in Alberta, Canada. Interviews were conducted using the Theoretical Domains Framework and Consolidated Framework for Implementation Research. Survey results are presented descriptively. Qualitative data were transcribed, coded and analysed according to grounded theory principles. Results A total of 20 PCPs and 39 respirologists completed surveys while 9 PCPs, 10 respirologists and 8 radiologists were interviewed. Sixty-one per cent of PCPs had not heard of the term ILA previously and only 13% were comfortable managing ILAs. Most respirologists (64%) did not follow a standardised approach to managing ILAs. Most PCPs and respirologists supported the development of a standardised care pathway for ILAs detected through LCS. Thematic analysis explored current knowledge and perspectives on management, clinical approach and recommendations for future directions. Barriers to a standardised pathway included heterogeneous reporting, knowledge gaps in the natural history of ILAs and healthcare resource constraints. Conclusions This mixed-methods study provides valuable insight into the practice patterns and perceptions of PCPs, respirologists and radiologists regarding ILAs. Given the anticipated increase in ILA detection, we have conducted a needs assessment that will be foundational to building standardised care pathways for ILAs.