Perspectives of family physicians towards access to lung cancer screening for individuals living with low income \u2013 a qualitative study

Ambreen Sayani,Stephen W Hwang,Mary Ann O'Brien,Peter Selby,Aisha Lofters,Geoffrey Liu,Mandana Vahabi,Erika Nicholson

doi:10.1186/s12875-020-01354-z

Abstract

BackgroundIndividuals living with low income are less likely to participate in lung cancer screening (LCS) with low-dose computed tomography. Family physicians (FPs) are typically responsible for referring eligible patients to LCS; therefore, we sought to understand their perspectives on access to lung cancer screening for individuals living with low income in order to improve equity in access to LCS.MethodsA theory-informed thematic analysis was conducted using data collected from 11 semi-structured interviews with FPs recruited from three primary care sites in downtown Toronto. Data was coded using the Systems Model of Clinical Preventative Care as a framework and interpretation was guided by the synergies of oppression analytical lens.ResultsFour overarching themes describe FP perspectives on access to LCS for individuals living with low income: the degree of social disadvantage that influences lung cancer risk and opportunities to access care; the clinical encounter, where there is often a mismatch between the complex health needs of low income individuals and structure of health care appointments; the need for equity-oriented health care, illustrated by the neglect of structural origins of health risk and the benefits of a trauma-informed approach; and finally, the multiprong strategies that will be needed in order to improve equity in health outcomes.ConclusionAn equity-oriented and interdisciplinary team based approach to care will be needed in order to improve access to LCS, and attention must be given to the upstream determinants of lung cancer in order to reduce lung cancer risk.

Highlights

Individuals living with low income are less likely to participate in lung cancer screening (LCS) with low-dose computed tomography
Family physician (FP) described their individual practice to consist of a high prevalence of those living with low income (S1), experiencing homelessness (S2) and/or suffering from multiple addictions and psychosocial problems (S3)
Our qualitative study which contextualizes the lived experiences of poverty and the choice to participate in LCS for individuals living with low income in Ontario is described elsewhere [24]

Summary

Introduction

Individuals living with low income are less likely to participate in lung cancer screening (LCS) with low-dose computed tomography. Physicians (FPs) are typically responsible for referring eligible patients to LCS; we sought to understand their perspectives on access to lung cancer screening for individuals living with low income in order to improve equity in access to LCS. The National Lung Screening Trial (NLST) published in 2011 demonstrated that screening with low-dose CT (LDCT) versus x-ray led to detection of more lung cancers and fewer lung cancer deaths after seven years of follow-up. In Canada, it is currently a health system priority to plan and implement lung cancer screening (LCS) for individuals at a high-risk of developing lung cancer, i.e. individuals between the ages of 55 and 74 years who have a 30 pack year smoking history (pack-year defined as the [average number of cigarette packs smoked daily] x [number of years smoking]) or quit smoking less than fifteen years ago [4]. In Ontario, this mandate is currently undergoing pilot testing by the provincial healthcare agency Ontario Health across four locations in the region

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