Attitudes and Beliefs Toward Lung Cancer Screening Among US Veterans

Abstract

Background: Lung cancer (LC) is the leading cause of cancer-related death for veterans cared for by the US Veterans Health Administration. The LC burden among veterans is almost double that of the general population. Before implementation of an LC screening program, we set out to assess the role of beliefs and attitudes toward LC screening among veterans. Methods: Veterans presenting to the Ralph H. Johnson VA Medical Center were invited to complete a self-administered survey. The survey comprised questions about demographics, smoking status, health status, and knowledge about LC and willingness to be screened. Responses from veteran ever and never smokers were compared. Results: A total of 209 veterans completed the survey. Smokers were signifi cantly ( P , .05) more likely than never smokers to be less educated, have a lower income, and report poorer health. Smokers were more likely than never smokers to have two or more comorbidities, which trended toward signifi cance ( P 5 .062). Smokers were more likely to have been told by a physician that they were at high risk for LC and to believe that they were at risk. Nearly all veterans surveyed (92.8%) would have a CT scan for LC screening, and 92.4% would have surgery for a screendetected LC. Conclusions: Veterans are overwhelmingly willing to undergo screening for LC, and it seems that participation will not be a barrier to implementation of an LC screening program. The mortality benefi t of LC screening, however, may not be generalizable to the veteran population because of a higher number of comorbid conditions.

Attitudes about Low-Dose Computed Tomography Screening for Lung Cancer: A Survey of American Thoracic Society Clinicians

“…Individuals who perceive LDCT screening more favorably may have been more likely to participate than those apathetic to this issue, resulting in overestimates of enthusiasm for LDCT screening. However, the enthusiasm our respondents expressed for lung cancer screening is similar to that observed in prior primary care provider and patient surveys (9,10). Second, responses to hypothetical vignettes may not reflect actual screening behavior.…”

Framing Discussions About CT Scan Screening for Lung Cancer So That Patients See the Whole Picture

“…Tanner and colleagues 5 found that virtually all (93%) of their survey respondents would accept CT scan screening for lung cancer, a somewhat surprising result in light of prior surveys of attitudes toward screening among smokers. 6 , 7 There is potential for bias in the design and administration of this survey, however, and as such, there are reasons to be cautious before concluding that CT scan screening for lung cancer would be so widely accepted.…”

“…In this issue of CHEST (see page 1783), Tanner and colleagues 5 take an important step forward by examining veterans' perceptions of their personal risk of lung cancer, their attitudes toward CT scan screening, and their willingness to undergo surgery for lung cancer. These are all important issues because current and former smokers-the target demographic for lung cancer screening-tend to underestimate their risk of cancer and to be less receptive to both screening and surgery for lung cancer.…”

“…Fortunately, there are tools available to facilitate this discussion. 10 , 11 Tanner and colleagues 5 have shown that most of the people they surveyed value the potential benefi t of CT scan screening for lung cancer. It is crucial to listen to patients, and this result supports recommendations from the American College of Chest Physicians and the US Preventive Services Task Force for healthcare systems to begin offering screening to eligible individuals.…”

Thinking Forward: Future-oriented Thinking among Patients with Tobacco-associated Thoracic Diseases and Their Surrogates

“…These decisions are often complex given the potential tradeoffs between quality and duration of life. The advent of new technologies and a greater appreciation for patient-centered care expands these complexities, as in the case of recommendations for advance care planning in the routine management of chronic obstructive pulmonary disease (COPD) (8) and for low-dose computed tomography scanning of individuals with significant tobacco histories (9)(10)(11)(12)(13).…”