Emotions and lung cancer screening: Prioritising a humanistic approach to care

Abstract

Low‐dose computed tomography lung cancer screening has mortality benefits. Yet, uptake has been low. To inform strategies to better deliver and promote screening, in 2018, we interviewed 27 long‐term smokers immediately following lung cancer screening in Australia, prior to receiving scan results. Existing lung screening studies employ the Health Belief Model. Reflecting growing acknowledgement of the centrality of emotions to screening uptake, we draw on psychological and sociological theories on emotions to thematically and abductively analyse the emotional dimensions of lung cancer screening, with implications for screening promotion and delivery. As smokers, interviewees described feeling stigmatised, with female participants internalising and male participants resisting stigma. Guilt and fear related to lung cancer were described as screening motivators. The screening itself elicited mild positive emotions. Notably, interviewees expressed gratitude for the care implicitly shown through lung screening to smokers. More than individual risk assessment, findings suggest lung screening campaigns should prioritise emotions. Peer workers have been found to increase cancer screening uptake in marginalised communities, however the risk to confidentiality—especially for female smokers—limits its feasibility in lung cancer screening. Instead, we suggest involving peer consultants in developing targeted screening strategies that foreground emotions. Furthermore, findings suggest prioritising humanistic care in lung screening delivery. Such an approach may be especially important for smokers from low socioeconomic backgrounds, who perceive lung cancer screening and smoking as sources of stigma and face a higher risk of dying from lung cancer and lower engagement with screening.

Imperatives of health or happiness: Narrative constructions of long-term smoking after undergoing lung screening

“…Instead of invoking or reinforcing narratives of responsibilisation and choice, campaigns would be better served by narratives which resist stigma: by positioning smokers as victims of circumstance and addiction. It is noteworthy that nearly all interviewees in our study started smoking in their teens, many in their early teens (Olson et al, forthcoming; Charles). Emphasising that many long-term smokers are trapped in addictive habits that began early in life, would serve to medicalise smoking (Furedi, 2008), positioning smokers as victims of circumstance, in need and deserving of care (Mol, 2008).…”

“…Here, we analyse the storied experiences of smoking and smoking cessation that attend to the moral challenge posed by stigma (Broom and Whittaker, 2004; Rance et al, 2017). Findings on participants’ experiences of lung screening are reported elsewhere (Olson et al, forthcoming). Our approach offers insight into ‘contradictory layers of meaning’ and the interplay between the personal and rhetorical (Andrews et al, 2008: 1; Clandinin and Rosiek, 2014).…”

Lung Cancer Screening: Implementation Challenges and Health Equity Considerations For the Western Pacific Region

“…Significant barriers to LCS uptake have been identified, including practical barriers (travel time and associated costs, work and/or career responsibilities), the impact of comorbidities, and emotional barriers (fear, shame, fatalism, avoidance, and low risk perception) inclusive of stigma. 36 - 39 To enable equitable participation, LCS programs need to address age, sex differences, current and past smoking status, socioeconomic status, and geographical factors. 38 …”

Lung cancer screening program factors that influence psychosocial outcomes: A systematic review

“…A PRISMA flow diagram of search results is presented in Figure 1 16 . Following screening, 32 articles were selected for inclusion; key characteristics are summarised in Table 2 6,17–47 . Study designs included RCTs ( n = 3), pre‐post studies ( n = 6), cross‐sectional studies ( n = 12), mixed‐methods studies ( n = 1), and qualitative studies ( n = 10).…”

“…29 Regarding the LDCT scan experience, two studies reported that it was not an issue for most participants. 33,42 In one instance, compared with people most worried about the prospect of scanning or waiting for results, the few people who cited that they were most concerned about the actual LDCT experienced more discomfort during scanning. 42 The same study also found that those who reported dread or discomfort while waiting for their result had significantly worse anxiety and lung cancer-specific distress (but not health-related quality of life) overall than those who were not concerned about the result.…”