{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T09:52:13Z","timestamp":1751968333297,"version":"3.37.3"},"reference-count":10,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,1,5]],"date-time":"2023-01-05T00:00:00Z","timestamp":1672876800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Rationale<\/jats:title><jats:p>Incidental radiographic findings are common, and primary care providers (PCPs) are often charged with the conducting or initiating an appropriate evaluation. Clinical guidelines are available for management of common \u2018incidentalomas\u2019 including lung and adrenal nodules, but guidelines\u2010adherent evaluations are not always performed; for example, in the setting of incidental adrenal masses (IAMs), recent literature suggests that an evidence\u2010based evaluation occurs in &lt;25% of patients for whom it is warranted\u2014a quality and safety concern.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims and Objectives<\/jats:title><jats:p>The objective of this study was to examine whether point\u2010of\u2010care access to concise clinical guidelines would promote appropriate evaluations of two common incidentalomas: IAMs and lung nodules.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>This study was a survey\u2010based, single\u2010blinded, randomized experiment of decision\u2010making within clinical vignettes. Respondents were PCPs in a variety of clinical practice settings, and half were randomly assigned to surveys that included concise clinical guidelines while the other half served as controls without access to guidelines. Scenarios involved patients with IAMs and lung nodules, and the scenarios included both higher\u2010risk and lower\u2010risk lesions. Our primary analysis examined safe versus inappropriate clinical decisions, while a secondary analysis compared guidelines\u2010concordant versus guidelines\u2010discordant responses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For both the higher\u2010risk IAM and higher\u2010risk lung nodule scenarios, safe answer choices were selected at a similar rate by respondents regardless of whether they had access to guidelines or not. However, for the lower risk scenarios, inappropriate answer choices were chosen substantially more frequently by respondents without access to guidelines compared to those with the guidelines (lung: 29.3% vs. 4.5%, <jats:italic>p<\/jats:italic>\u2009=\u20090.003, adrenal: 31.6% vs. 7.0%, <jats:italic>p<\/jats:italic>\u2009=\u20090.01). There was less variation in the secondary analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Survey respondents were significantly more likely to make safe management decisions in lower\u2010risk clinical scenarios when clinical guidelines were available. Point\u2010of\u2010care access to clinical guidelines for incidentalomas is an intervention that may reduce management errors and improve patient safety.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jep.13806","type":"journal-article","created":{"date-parts":[[2023,1,5]],"date-time":"2023-01-05T15:17:41Z","timestamp":1672931861000},"page":"632-638","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Point\u2010of\u2010care access to clinical guidelines may improve management of incidental findings in the primary care setting"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6361-9842","authenticated-orcid":false,"given":"Chandler A.","family":"Annesi","sequence":"first","affiliation":[{"name":"Boston University School of Medicine Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie D.","family":"Talutis","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Vascular Surgery University of California Los Angeles  Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna L.","family":"Goldman","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Endocrinology Boston Medical Center  Boston Massachusetts USA"},{"name":"Department of Medicine, Section of Endocrinology Boston University School of Medicine Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellen","family":"Childs","sequence":"additional","affiliation":[{"name":"Abt Associates  Rockville Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip E.","family":"Knapp","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Endocrinology Boston Medical Center  Boston Massachusetts USA"},{"name":"Department of Medicine, Section of Endocrinology Boston University School of Medicine Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"McAneny","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Endocrine Surgery Boston University School of Medicine Boston Massachusetts USA"},{"name":"Department of Surgery, Section of Endocrine Surgery Boston Medical Center  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frederick Thurston","family":"Drake","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Endocrine Surgery Boston University School of Medicine Boston Massachusetts USA"},{"name":"Department of Surgery, Section of Endocrine Surgery Boston Medical Center  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,1,5]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.18.20083"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.sult.2018.02.006"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-16-0467"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2017161659"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00261-019-02149-2"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2021.07.041"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2021.03.038"},{"key":"e_1_2_9_9_1","unstructured":"ZimmermanB. 5 Safety\u2010net Hospitals Health Systems to Know.\u00a0Becker's Hospital Review.\u00a02022. Accessed November 9 2022.https:\/\/www.beckershospitalreview.com\/lists\/5-safety-net-hospitals-health-systems-to-know.html"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2017.07.030"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000542"}],"container-title":["Journal of Evaluation in Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jep.13806","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jep.13806","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jep.13806","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T17:37:50Z","timestamp":1692466670000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jep.13806"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,5]]},"references-count":10,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,6]]}},"alternative-id":["10.1111\/jep.13806"],"URL":"https:\/\/doi.org\/10.1111\/jep.13806","archive":["Portico"],"relation":{},"ISSN":["1356-1294","1365-2753"],"issn-type":[{"type":"print","value":"1356-1294"},{"type":"electronic","value":"1365-2753"}],"subject":[],"published":{"date-parts":[[2023,1,5]]},"assertion":[{"value":"2022-09-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-14","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-05","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}