Dr Joelle Fathi has many years’ experience working in incidental pulmonary nodule (IPN) management – having helped to set up an integrated programme more than a decade ago. Here she explains what it takes to make sure that no nodule, and no person, is overlooked.
This Lung Cancer Awareness Month, we spoke with Network member Dr Joelle Fathi about her experience of incidental pulmonary nodule (IPN) management, the role of patient navigation in making sure people are not lost to follow-up, and her advice for anyone setting up a programme of their own.
What is your background in IPN management?
Currently, I work as the chief healthcare delivery officer at GO2 for Lung Cancer, but my experience with IPN management began as a board-certified nurse practitioner in thoracic surgery and interventional pulmonology, where I cared for many people whose lung cancer was identified through IPNs. In 2013, I established and co-led an IPN programme integrated with our tobacco-related diseases and lung cancer screening programme at the Swedish Medical Center in Seattle, Washington. The service aimed to improve nodule evaluation, follow-up and clinical care through diagnostic and treatment processes.
What does IPN management mean in your work today?
In my leadership role at GO2 for Lung Cancer, IPN management means creating opportunities for people to have their lung cancer identified earlier, when more treatment options may be available and outcomes can be more favourable. My team and I focus on advancing high-quality, person-centred IPN care through multidisciplinary workforce development, care coordination and evidence-based practices that help ensure individuals receive timely evaluation, follow-up and support throughout their diagnostic and treatment journey.
What have you seen IPN management achieve in practice?
My real-world clinical experience is centred on working directly with patients as part of a multidisciplinary team responsible for nodule evaluation and management, care coordination, diagnosis and treatment. I have seen first-hand that when clinicians are empowered to work at the top of their scope of practice and are equipped to support people across the entire care continuum, the potential of IPN programmes is tremendous. Effective IPN management is not simply about tracking nodules; it is about coordinating person-centred care to ensure timely follow-up, reduce delays and create opportunities to identify lung cancer earlier.
What does an effective IPN management programme need?
An effective IPN management programme requires strong organisational commitment, engaged leadership and sustained investment in the people, processes and technology needed to support high-quality care. Success depends on having the resources and infrastructure to capture and track every incidental pulmonary nodule at every point of entry into the health system, ensuring no person or nodule is overlooked.
How can patient navigation help people with IPNs?
Patient navigation plays a critical role in ensuring that individuals with IPNs receive timely, coordinated, and person-centred care. Importantly, ‘navigation’ can represent a broad range of healthcare professionals prepared to support IPN identification, management, diagnostic work-up and treatment, including nurses (and advanced practice nurses), respiratory therapists, administrative staff and others. Regardless of professional role, effective navigation helps ensure that patients move seamlessly through the care continuum, receive appropriate follow-up and avoid delays in care. The most successful IPN programmes embrace an ‘all hands on deck’ approach, leveraging the strengths of the entire care team to help every patient receive the right care at the right time.
If you want to learn more about patient navigation and its role in improving coordination in lung cancer services, read the Network’s report on patient navigation across the care pathway, which was developed in consultation with Dr Joelle Fathi.
Dr Joelle Fathi, GO2 for Lung Cancer
What is the most exciting development in IPN management in recent years?
What excites me most about IPN management today (compared with when I entered this field nearly 30 years ago) is the rapid pace of AI innovation and scientific discovery, which is creating new opportunities to identify and diagnose lung cancer more efficiently and accurately at its earliest stages. Equally inspiring are advances in minimally invasive treatments, precision oncology and targeted therapies.
Together, these developments are transforming what is possible for people with IPNs and hold significant promise for improving outcomes and quality of life.
What would you like to see next for IPN management?
In the future – and starting today – I want to see health systems place a greater priority on finding and managing IPNs as early as possible. We have increasingly sophisticated technology and effective treatments, but their impact depends on early identification. We must organise our systems around timely IPN detection and follow-up so more people can benefit from earlier diagnosis, earlier intervention and better health outcomes.
What advice would you give to anyone setting up an IPN management programme?
If organisations are already providing lung cancer screening, an IPN management programme is a natural and essential companion. The infrastructure, workflows and expertise are often already in place. If an organisation is not yet screening for lung cancer, my advice is to build both programmes at the same time. Together, they create a powerful opportunity to advance our shared goal of conquering lung cancer.
Find out how to plan, design and implement an IPN management programme in your own health system with the Network’s implementation toolkit for IPN management programmes.
