A qualitative study exploring patient motivations for screening for lung cancer

Joshua A Roth, Lisa Carter-Harris, Susan Brandzel, Diana S M Buist, Karen J Wernli, Joshua A Roth, Lisa Carter-Harris, Susan Brandzel, Diana S M Buist, Karen J Wernli

Abstract

Background: Low-dose computed tomography (LDCT) of the chest for lung cancer screening of heavy smokers was given a 'B' rating by the U.S. Preventive Services Task Force (USPSTF) in 2013, and gained widespread insurance coverage in the U.S. in 2015. Lung cancer screening has since had low uptake. However, for those that do choose to screen, little is known about patient motivations for completing screening in real-world practice.

Objective: To explore the motivations for screening-eligible patients to screen for lung cancer.

Methods: Semi-structured qualitative interviews were conducted with 20 LDCT screen-completed men and women who were members of an integrated mixed-model healthcare system in Washington State. From June to September 2015, participants were recruited and individual interviews performed about motivations to screen for lung cancer. Audio-recorded interviews were transcribed and analyzed using inductive content analysis by three investigators.

Results: Four primary themes emerged as motivations for completing LDCT lung cancer screening: 1) trust in the referring clinician; 2) early-detection benefit; 3) low or limited harm perception; and 4) friends or family with advanced cancer.

Conclusion: Participants in our study were primarily motivated to screen for lung cancer based on perceived benefit of early-detection, absence of safety concerns, and personal relationships. Our findings provide new insights about patient motivations to screen, and can potentially be used to improve lung cancer screening uptake and shared decision-making processes.

Conflict of interest statement

The authors have declared that no competing interests exist.

References

    1. Howlader N, Krapcho M, Neyman N, Aminou R, Waldron W, Altekruse S, et al. (eds). SEER Cancer Statistics Review, 1975–2009 2012. [cited 2012 8/23]. .
    1. Noone A, Cronin K, Altekruse S, Howlader N, Lewis D, Petkov V, et al. Cancer incidence and survival trends by subtype using data from the Surveillance Epidemiology and End Results Program, 1992–2013. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2016. Epub 2016/12/14. doi: .
    1. Aberle D, Adams A, Berg C, Black W, Clapp J, Fagerstrom R, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. The New England journal of medicine. 2011;365(5):395–409. Epub 2011/07/01. doi: .
    1. Moyer V. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160(5):330–8. Epub 2014/01/01. doi: .
    1. McCunney R, Li J. Radiation risks in lung cancer screening programs: a comparison with nuclear industry workers and atomic bomb survivors. Chest. 2014;145(3):618–24. Epub 2014/03/05.
    1. Graff S. Slow Uptake of Screening for Lung Cancer Highlights Obstacles. JNCI: Journal of the National Cancer Institute. 2017;109(4):djx078-djx.
    1. Carter-Harris L, Brandzel S, Wernli K, Roth J, Buist D. A qualitative study exploring why individuals opt out of lung cancer screening. Fam Pract. 2017. Epub 2017/01/27. doi: .
    1. Huo J, Shen C, Volk R, Shih Y. Use of ct and chest radiography for lung cancer screening before and after publication of screening guidelines: Intended and unintended uptake. JAMA Internal Medicine. 2017;177(3):439–41. doi:
    1. McKee B, Regis S, McKee A, Flacke S, Wald C. Performance of ACR Lung-RADS in a Clinical CT Lung Screening Program. Journal of the American College of Radiology: JACR. 2016;13(2 Suppl):R25–9. Epub 2016/02/06. doi: .
    1. Park E, Streck J, Gareen I, Ostroff J, Hyland K, Rigotti N, et al. A qualitative study of lung cancer risk perceptions and smoking beliefs among national lung screening trial participants. Nicotine & tobacco research: official journal of the Society for Research on Nicotine and Tobacco. 2014;16(2):166–73. Epub 2013/09/04. doi: .
    1. Zeliadt S, Heffner J, Sayre G, Klein D, Simons C, Williams J, et al. Attitudes and Perceptions About Smoking Cessation in the Context of Lung Cancer Screening. JAMA Intern Med. 2015;175(9):1530–7. Epub 2015/07/28. doi: .
    1. Thomas D. A general inductive approach for analyzing qualitative evaluation data. Am J Eval. 2006; 27: 237–46.
    1. Zapka J, Taplin S, Ganz P, Grunfeld E, Sterba K. Multilevel factors affecting quality: examples from the cancer care continuum. J Natl Cancer Inst Monogr. 2012;2012(44):11–9. doi: .
    1. Carter-Harris L, Ceppa D, Hanna N, Rawl S. Lung cancer screening: what do long-term smokers know and believe? Health expectations: an international journal of public participation in health care and health policy. 2015. Epub 2015/12/25. doi: .
    1. Schapira M, Aggarwal C, Akers S, Aysola J, Imbert D, Langer C, et al. How Patients View Lung Cancer Screening. The Role of Uncertainty in Medical Decision Making. Ann Am Thorac Soc. 2016;13(11):1969–76. doi: .
    1. Lillie S, Fu S, Fabbrini A, Rice K, Clothier B, Nelson D, et al. What factors do patients consider most important in making lung cancer screening decisions? Findings from a demonstration project conducted in the Veterans Health Administration. Lung Cancer. 2017;104:38–44. Epub 2017/02/19. doi: .
    1. Friedman L, Woodruff A, Lane M, Weinberg A, Cooper H, Webb J. Breast cancer screening behaviors and intentions among asymptomatic women 50 years of age and older. Am J Prev Med. 1995;11(4):218–23. Epub 1995/07/01. .
    1. Fyffe D, Hudson S, Fagan J, Brown D. Knowledge and barriers related to prostate and colorectal cancer prevention in underserved black men. J Natl Med Assoc. 2008;100(10):1161–7. Epub 2008/10/24. .
    1. Park E, Ostroff J, Rakowski W, Gareen I, Diefenbach M, Feibelmann S, et al. Risk perceptions among participants undergoing lung cancer screening: baseline results from the National Lung Screening Trial. Ann Behav Med. 2009;37(3):268–79. Epub 2009/08/28. doi: .
    1. Carter-Harris L, Tan A, Salloum R, Young-Wolff K. Patient-provider discussions about lung cancer screening pre- and post-guidelines: Health Information National Trends Survey (HINTS). Patient Educ Couns. 2016;99(11):1772–7. doi: .
    1. Reid R, Coleman K, Johnson E, Fishman P, Hsu C, Soman M, et al. The Group Health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers. Health Aff (Millwood). 2010;29(5):835–43. Epub 2010/05/05. doi: .
    1. Lau Y, Caverly T, Cherng S, Cao P, West M, Arenberg D, et al. Development and validation of a personalized, web-based decision aid for lung cancer screening using mixed methods: a study protocol. JMIR Res Protoc. 2014;3(4):e78 doi: .
    1. Agency for Healthcare Research and Quality. Lung Cancer Screening Tools for Patients & Clinicians. Accessed at: . Last accessed on: 7/11/2017.
    1. Memorial Sloan Kettering Cancer Center. Lung Cancer Screening Decision Tool. Accessed at: . Last accessed on: 7/11/2017.

Source: PubMed

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