Abstract
IntroductionNational guidelines call for annual lung cancer screening for high-risk smokers using low-dose computed tomography (LDCT). The objective of our study was to characterize patient knowledge and attitudes about lung cancer screening, smoking cessation, and shared decision making by patient and health care provider.MethodsWe conducted semistructured qualitative interviews with patients with histories of heavy smoking who received care at a Federally Qualified Health Center (FQHC Clinic) and at a comprehensive cancer center-affiliated chest clinic (Chest Clinic) in Albuquerque, New Mexico. The interviews, conducted from February through September 2014, focused on perceptions about health screening, knowledge and attitudes about LDCT screening, and preferences regarding decision aids. We used a systematic iterative analytic process to identify preliminary and emergent themes and to create a coding structure.ResultsWe reached thematic saturation after 22 interviews (10 at the FQHC Clinic, 12 at the Chest Clinic). Most patients were unaware of LDCT screening for lung cancer but were receptive to the test. Some smokers said they would consider quitting smoking if their screening result were positive. Concerns regarding screening were cost, radiation exposure, and transportation issues. To support decision making, most patients said they preferred one-on-one discussions with a provider. They also valued decision support tools (print materials, videos), but raised concerns about readability and Internet access.ConclusionImplementing lung cancer screening in sociodemographically diverse populations poses significant challenges. The value of tobacco cessation counseling cannot be overemphasized. Effective interventions for shared decision making to undergo lung cancer screening will need the active engagement of health care providers and will require the use of accessible decision aids designed for people with low health literacy.
Highlights
National guidelines call for annual lung cancer screening for highrisk smokers using low-dose computed tomography (LDCT)
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions
Sociodemographic characteristics of participants and their views on cancer screening We interviewed 22 clinic patients, 12 from Chest a comprehensive cancer center-affiliated chest clinic (Clinic) and 10 from Federally Qualified Health Center (FQHC) Clinic
Summary
National guidelines call for annual lung cancer screening for highrisk smokers using low-dose computed tomography (LDCT). Recently declining smoking rates may reduce lung cancer incidence [1], former smokers remain at a high risk for the disease, and most lung cancers occur in former smokers [3]. The multicenter National Lung Screening Trial (NLST) enrolled 53,454 high-risk smokers, defined as people aged 55 to 74 years with a 30 pack year smoking history, who were either current smokers or had quit within the previous 15 years [5]. Lung cancer deaths among NLST participants randomly assigned to low-dose computed tomography (LDCT) were significantly reduced (16.0% [relative] [6] and 0.33% [absolute] [5] risk decrease) compared with those who had chest x-ray. Concerns remain regarding the high false positive rates and complications following invasive diagnostic procedures (ie, percutaneous biopsy, bronchoscopy, or surgical procedure) [5]
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