The Current Impact of Incidental Findings Found during Neuroimaging on Neurologists’ Workloads

Objective
Neuroimaging is an important diagnostic tool in the assessment of neurological disease, but often unmasks Incidental Findings (IFs). The negative impacts of IFs, such as ‘patient’ anxiety, present neurologists with management dilemmas, largely due to the limited knowledge base surrounding the medical significance of these IFs. In particular, the lack of evidence-based clinical trials investigating the efficacy of treatments for subclinical IFs makes management protocols challenging. The objective was to determine the impact IFs may have on neurologists’ workloads and healthcare budgets and to examine neurologists’ concerns regarding the clinical management of these ‘patients’.
Methods
Qualitative research based on constructivist grounded theory. Data was collected through semi-structured interviews of purposively sampled neurologists, coded, and concurrent comparative analysis performed. A substantive theory of the ‘IF impacts’ was developed after concept saturation.
Results
Neurologists managed the escalating workload caused by an increased number of referrals of ‘patients’ with IFs found during neuroimaging; however it was unclear whether this was sustainable in the future. Neurologists experienced IF management dilemmas and spent more time with ‘patients’ affected by anxiety. The lack of information provided to those undergoing neuroimaging by the referring clinician regarding the possibility of discovering IFs was highlighted.
Conclusion
The impact of IFs upon the neurologist, ‘patient’ and the health institution appeared considerable. Further research determining the natural history of subclinical IFs and the efficacy of intervention will help to alleviate these issues.

研究目标
神经影像学是评估神经系统疾病的重要诊断工具，但时常会检出意外发现（Incidental Findings，IFs）。此类意外发现的负面影响（如引发“患者”焦虑）给神经科医师带来了诊疗困境，这主要是因为目前针对这些意外发现的医学意义的知识库较为匮乏。尤其值得注意的是，目前缺乏针对亚临床型意外发现的治疗有效性的循证临床试验，这使得相关诊疗规范的制定颇具挑战。本研究旨在明确意外发现对神经科医师工作量与医疗预算的潜在影响，并探讨神经科医师在管理此类“患者”时所面临的顾虑。

研究方法
采用基于建构主义扎根理论的质性研究。通过对目的性抽样选取的神经科医师进行半结构化访谈收集数据，随后对访谈内容进行编码，并开展同步比较分析。待概念饱和后，构建出关于“意外发现影响”的实质性理论。

研究结果
神经科医师需应对因神经影像学检查中检出意外发现的“患者”转诊量增加所导致的不断攀升的工作量，但目前尚不清楚此种工作模式未来是否具备可持续性。神经科医师在处理意外发现相关诊疗时面临困境，且需花费更多时间与因意外发现产生焦虑的“患者”沟通。研究同时指出，转诊医师未向接受神经影像学检查的患者告知可能检出意外发现这一情况。

研究结论
意外发现对神经科医师、“患者”以及医疗机构均产生了显著影响。未来需开展相关研究以明确亚临床型意外发现的自然病程及干预措施的有效性，从而助力缓解上述问题。