Attitudes towards lung cancer screening in socioeconomically deprived and heavy smoking communities: informing screening communication

Abstract

BackgroundWhile discussion continues over the future implementation of lung cancer screening, low participation from higher risk groups could limit the effectiveness of any national screening programme.ObjectivesTo compare smokers’ beliefs about lung cancer screening with those of former and never smokers within a low socioeconomic status (SES) sample, to explore the views of lower SES smokers and ex‐smokers in‐depth, and to provide insights into effective engagement strategies.Design, setting and participantsUsing proactive, community‐based recruitment methods, we surveyed 175 individuals from socioeconomically deprived communities with high smoking prevalence and subsequently interviewed 21 smokers and ex‐smokers. Participants were approached in community settings or responded to a mail‐out from their housing association.ResultsInterviewees were supportive of screening in principle, but many were doubtful about its ability to deliver long‐term survival benefit for their generation of “heavy smokers.” Lung cancer was perceived as an uncontrollable disease, and the survey data showed that fatalism, worry and perceived risk of lung cancer were particularly high among smokers compared with non‐smokers. Perceived blame and stigma around lung cancer as a self‐inflicted smokers’ disease were implicated by interviewees as important social deterrents of screening participation. The belief that lungs are not a treatable organ appeared to be a common lay explanation for poor survival and undermined the potential value of screening.ConclusionsAttitudes towards screening among this high‐risk group are complex. Invitation strategies need to be carefully devised to achieve equitable participation in screening.

It’s hard to reach the “hard-to-reach”: the challenges of recruiting people who do not access preventative healthcare services into interview studies

“…A number of studies have described identifying non-attendeers from health records held by service providers and contacting the individuals directly by phone or letter to invite them to participate (Hall et al, 2015; McCaffery et al, 2001; Oscarsson, Mijma, & Benzein, 2008). Other studies have described forging links with community leaders to access their networks and approach individuals directly (Quaife, Marlow, McEwen, Janes, & Wardle, 2016) or have offered financial incentives to encourage participation (Ellis et al, 2015). …”

Developing and testing a brief clinic‐based lung cancer screening decision aid for primary care settings

“…Additional options were available to allow patients to create their own statements. The 14 statements were based on concerns reported during the primary author's experience with participants of another lung cancer screening study and on the literature (see Table ) …”

How is knowledge shared in Public involvement? A qualitative study of involvement in a health technology assessment

“…Finally, members of the public were encouraged to discuss the perspective of smokers/ former smokers from deprived areas on the introduction of a lung cancer screening programme. Discussion was aided by using data from a qualitative interview study published in 2017 . LL facilitated discussions by presenting the findings of this study as visual models (Figure ) .…”

“…Discussion was aided by using data from a qualitative interview study published in 2017. 22 LL facilitated discussions by presenting the findings of this study as visual models ( Figure 3). 23 The groups were run strictly to time, and the facilitators (KL and LL) aimed to moderate the groups so that everyone had the opportunity to speak.…”