Abstract
Psychological considerations within the realm of lung cancer screening are broad and span a number of areas. The aim of this talk is to give a brief overview of some of these areas. Firstly, an understanding of psychosocial factors can help program leaders develop campaigns to promote services and better target specific populations that demonstrate risk (Irwin et al., 2019; Montano et al., 1997). There are specific psychosocial factors including anxiety, fatalism, and concerns regarding stigma that impact the willingness of individuals and specific populations to accept screening (Quaife et al., 2017). Strategies for targeting these concerns include directly addressing these areas with patients, and coaching providers and medical team members to intervene. Secondly, tobacco/smoking cessation is vital to decreasing risk of lung cancer as well as a host of other illnesses and all cause mortality (Li et al., 2020). Psychology has an important role in engaging patients with quitting services and providing support and programming during quitting (Iaccarino et al., 2019). Motivational interviewing strategies have been shown to be particularly important in generating treatment engagement around addiction services in general, and tobacco cessation in particular (Miller & Rollnick, 2013). Efforts to convince patients to engage often backfire, while approaching individuals with curiosity and allowing space for patients to explore their own motivation to quit generate increased motivation. It is optimal that all program staff are aware of motivational interviewing principles and work together to create an atmosphere of partnership, acceptance, and compassion. Once tobacco/smoking cessation treatment has been accepted, matching individuals with modalities that fit their preferences, and are also most likely to generate successful outcomes, becomes important (Carter-Harris et al., 2018). Having recommendations for diverse modalities including in-person services, telephone services, text support, and apps allows patients to engage in ways that can minimize drop out from treatment. Providing a combination of medication and support resources as well as services that can provide support throughout the timeframe of quitting have also been shown to generate the greatest success in quitting. Finally, as with screening for any potentially serious diagnosis, patients can respond with significant distress at any point in the process (Byrne et al., 2008). In particular, waiting for results, receiving significant findings, or receiving inconclusive results are particularly risky times (Dunn et al., 2017). It is important for program staff to be aware of psychological signs indicating a need for additional services, and what types of services are best suited to address these concerns. Cognitive behavioral and mindfulness-based interventions have demonstrated significant positive outcomes for lessening distress in cancer patients following diagnosis and during treatment (Carlson, 2017). These treatments lessen distress by assisting patients in changing behaviors, thoughts, and their relationship to both cognitive and affective responses to stress. Byrne, M. M., Weissfeld, J., & Roberts, M. S. (2008). Anxiety, fear of cancer, and perceived risk of cancer following lung cancer screening. Medical Decision Making 28(Nov-Dec), 917-925. https://doi.org/10.1177/0272989X08322013 Carlson, M. (2017). CBT for psychological well-being in cancer: A skills training manual integrating DBT, ACT, behavioral activation and motivational interviewing (1st ed.). John Wiley & Sons Ltd. https://doi.org/10.1002/9781119161370 Carter-Harris, L., Shwindt, R., Bakoyannis, G., Ceppa, D. P. (2018). Current smokers’ preferences for receiving cessation information in a lung cancer screening setting. Journal of Cancer Education 33(5), 1120-1125. https://doi.org/10.1007/s13187-017-1222-7 Dunn, C. E., Edwards, A., Carter, B., Field, J. K., Brain, K., & Lifford, K. J. (2017). The role of screening expectations in modifying short-term psychological responses to low-dose computed tomography lung cancer screening among high risk individuals. Patient Education and Counseling 100, 1572-1579. https://dx.doi.org/10.1016.j.pec.2017.02.024 Iaccarino, J. M., Duran, C., Slatore, C. G., Weiner, R. S., & Kathuria, H. (2019). Combining smoking cessation intervention with LDCT lung cancer screening: A systematic review. Preventive Medicine 121, 24-32. https://doi.org/10.1016/j.ypmed.2019.02.016 Irwin, K. E., Stefens, E. B., Yoon, Y., Flores, E., J., Knight, H. P., Pirl, W. F., Freudenreich, O., Henderson, D. C., & Park, E. R. (2019). Lung cancer screening eligibility, risk perceptions, and clinician delivery of tobacco cessation among patients with schizophrenia. Psychiatric Services 70, 927-934. https://doi.org/10.1176/appi.ps.201900044 Li, J., Chung, S., Martinez, M. C., & Luft, H. S. (2020). Smoking-cessation interventions after lung cancer screening guidelines change. American Journal of Preventive Medicine 59(1), 88-97. https://doi.org/10.1016/j.amepre.2020.01.031 Miller, W. R., & Rollnick, S. (2013). Motivational interviewing (3rd ed.). The Guilford Press. Montano, D. E., Kasprzyk, D., Taplin, S. H. (1997). The theory of reasoned action and the theory of planned behavior. In K. Glanz, F. M. Lewis, & B. K. Rimer (Eds.), Health behavior and health education: Theory, research, and practice (pp. 85-112). Jossey-Bass Inc. Quaife, S. L., Marlow, L. A. V., McEwen, A., Janes, S. M., & Wardle, J. (2017). Attitudes towards lung cancer screening in socioeconomically deprived and heavy smoking communities: informing screening communication. Health Expectations 20, 563-573. https://doi.org/10.1111/hex.12481
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