P1.03-060 Lung Cancer Screening: A Qualitative Study Exploring the Decision to Opt Out of Screening

Abstract

Lung cancer screening (LCS) with annual low-dose computed tomography is relatively new for long-term smokers in the US supported by a US Preventive Services Task Force Grade B recommendation. As LCS programs are more widely implemented and providers engage patients about LCS, it is critical to understand what influences the decision to screen, or not, for lung cancer. Understanding LCS behavior among high-risk smokers who opt out provides insight, from the patient perspective, about the shared decision-making (SDM) process. This study explored LCS-eligible patients’ decision to opt out of LCS after receiving a provider recommendation. New knowledge will inform intervention development to enhance SDM processes between high-risk smokers and their provider, and decrease decisional conflict about LCS. Semi-structured qualitative interviews were performed with 18 LCS-eligible men and women who were members of an integrated healthcare system in Seattle about their decision to opt out of screening. Participants met LCS criteria for age, smoking and pack-year history. Audio-recorded interviews were transcribed verbatim. Two researchers with cancer screening and qualitative expertise conducted data analysis using thematic content analytic procedures. Participant mean age was 66 years (SD 6.5). Majority were female (61%), Caucasian (83%), current smokers (61%). Five themes emerged: 1) Knowledge Avoidance; 2) Perceived Low Value; 3) False Positive Worry; 4) Practical Barriers; and 5) Misunderstanding. Representative thematic example quotes are presented in the Table below.Tabled 1Knowledge Avoidance“It’s fear of the unknown…if I know, you have to follow through and do more and more.”Perceived Low Value“It could show me if I had lung cancer…what are they going to do?...screening doesn’t really make any difference...”False Positive Worry“I did schedule one…then after I read the print out, I canceled it…the false positives were so high. I thought why… that would be so stressful…”Practical Barriers“I really didn’t have time to get over there.”Misunderstanding“I wasn’t hurting or having any problems breathing…wasn’t a top priority for me” [reflecting misunderstanding of the concept of screening] Open table in a new tab Many screening-eligible smokers opt out of LCS. Participants in our study provided new insights into why some patients make this choice. LCS is effective in early lung cancer detection among high-risk patients. However, LCS has associated risks and harms making the SDM process critical. Understanding why people decide not to screen will enhance future efforts to improve knowledge transfer from providers to patients about the risks and benefits of LCS and ultimately enhance SDM about screening.