删除肺功能测试（PFT）中的种族校正是一项优先任务，因为种族校正不适当地将社会构造种族与生物差异混为一谈，并错误地假设非裔美国人的肺功能较白人差。然而，撤销对患有肺癌的非裔美国患者进行PFTs的种族校正的影响尚不清楚。为了确定有多少进行肺癌手术的医院使用了种族校正，在种族校正与预测肺功能之间的关联，以及测试撤销对外科医生治疗建议的影响。在这项质量改进研究中，与州内质量合作的医院进行了联系，以确定PFTs中是否使用了种族校正。对于进行种族校正的医院，使用种族校正和种族中立的等式计算了2015年1月1日至2022年9月31日期间接受肺癌切除术的非裔美国患者的术前和术后1秒用力呼气容积（FEV1）的百分比预测。然后，将美国心胸外科医生随机分为接收1个临床病例的组，这些病例根据对非裔美国患者（术后FEV1百分比预测值为49%）、其他种族或多种族患者（术后FEV1百分比预测值为45%）和种族中立患者（术后FEV1百分比预测值为42%）使用全球肺功能倡议等式的不同来描述。有多少医院在PFTs中使用种族校正，根据种族中立或种族校正的等式改变术前和术后FEV1估计值的变化及医生对临床病例的治疗建议。研究纳入了515名非裔美国患者（308名[59.8%]女性；平均[标准偏差]年龄为66.2[9.4]岁）。研究期间进行肺癌切除手术的16个医院中有15个（93.8%）报告使用种族校正，这对应着473名非裔美国患者（91.8%）接受了种族校正的PFTs。在这些患者中，如果使用种族中立的等式，则术前FEV1百分比预测值和术后FEV1百分比预测值将分别下降9.2% (95% CI, -9.0% to -9.5%; P < .001) 和7.6% (95% CI, -7.3% to -7.9%; P < .001)。成功随机分配并完成风险感知和治疗结果相关问题的医生共计225名（男性194名[87.8%]；实践时间均值[标准偏差]为19.4[11.3]年），完成率为76%。与将接受种族校正PFTs的病例随机分配的医生相比，将接受其他种族或多种族校正（61.7%; 95% CI, 51.1%-72.3%; P = .02）或种族中立PFTs（52.8%; 95% CI, 41.2%-64.3%; P = .001）的医生更有可能推荐行肺叶切除术（79.2%; 95% CI, 69.8%-88.5%）。鉴于这项质量改进研究的发现，外科医生应意识到PFT测试的变化，因为撤销种族校正的PFTs可能改变外科医生的治疗决策，并可能加剧非裔美国患者接受肺癌手术的现有差异。

Removal of race correction in pulmonary function tests (PFTs) is a priority, given that race correction inappropriately conflates race, a social construct, with biological differences and falsely assumes worse lung function in African American than White individuals. However, the impact of decorrecting PFTs for African American patients with lung cancer is unknown.To identify how many hospitals providing lung cancer surgery use race correction, examine the association of race correction with predicted lung function, and test the effect of decorrection on surgeons' treatment recommendations.In this quality improvement study, hospitals participating in a statewide quality collaborative were contacted to determine use of race correction in PFTs. For hospitals performing race correction, percent predicted preoperative and postoperative forced expiratory volume in 1 second (FEV1) was calculated for African American patients who underwent lung cancer resection between January 1, 2015, and September 31, 2022, using race-corrected and race-neutral equations. US cardiothoracic surgeons were then randomized to receive 1 clinical vignette that differed by the use of Global Lung Function Initiative equations for (1) African American patients (percent predicted postoperative FEV1, 49%), (2) other race or multiracial patients (percent predicted postoperative FEV1, 45%), and (3) race-neutral patients (percent predicted postoperative FEV1, 42%).Number of hospitals using race correction in PFTs, change in preoperative and postoperative FEV1 estimates based on race-neutral or race-corrected equations, and surgeon treatment recommendations for clinical vignettes.A total of 515 African American patients (308 [59.8%] female; mean [SD] age, 66.2 [9.4] years) were included in the study. Fifteen of the 16 hospitals (93.8%) performing lung cancer resection for African American patients during the study period reported using race correction, which corresponds to 473 African American patients (91.8%) having race-corrected PFTs. Among these patients, the percent predicted preoperative FEV1 and postoperative FEV1 would have decreased by 9.2% (95% CI, -9.0% to -9.5%; P < .001) and 7.6% (95% CI, -7.3% to -7.9%; P < .001), respectively, if race-neutral equations had been used. A total of 225 surgeons (194 male [87.8%]; mean [SD] time in practice, 19.4 [11.3] years) were successfully randomized and completed the vignette items regarding risk perception and treatment outcomes (76% completion rate). Surgeons randomized to the vignette with African American race-corrected PFTs were more likely to recommend lobectomy (79.2%; 95% CI, 69.8%-88.5%) compared with surgeons randomized to the other race or multiracial-corrected (61.7%; 95% CI, 51.1%-72.3%; P = .02) or race-neutral PFTs (52.8%; 95% CI, 41.2%-64.3%; P = .001).Given the findings of this quality improvement study, surgeons should be aware of changes in PFT testing because removal of race correction PFTs may change surgeons' treatment decisions and potentially worsen existing disparities in receipt of lung cancer surgery among African American patients.