Motivation is not enough: A qualitative study of lung cancer screening uptake in Australia to inform future implementation

Abstract

Introduction Participation in lung cancer screening (LCS) trials and real-world programs is low, with many people at high-risk for lung cancer opting out of baseline screening after registering interest. We aimed to identify the potential drivers of participation in LCS in the Australian setting, to inform future implementation. Methods Semi-structured telephone interviews were conducted with individuals at high-risk of lung cancer who were eligible for screening and who had either participated (‘screeners’) or declined to participate (‘decliners’) in the International Lung Screening Trial from two Australian sites. Interview guide development was informed by the Precaution Adoption Process Model. Interviews were audio-recorded, transcribed and analysed using the COM-B model of behaviour to explore capability, opportunity and motivation related to screening behaviour. Results Thirty-nine participants were interviewed (25 screeners; 14 decliners). Motivation to participate in screening was high in both groups driven by the lived experience of lung cancer and a belief that screening is valuable, however decliners unlike their screening counterparts reported low self-efficacy. Decliners in our study reported challenges in capability including ability to attend and in knowledge and understanding. Decliners also reported challenges related to physical and social opportunity, in particular location as a barrier and lack of family support to attend screening. Conclusion Our findings suggest that motivation alone may not be sufficient to change behaviour related to screening participation, unless capability and opportunity are also considered. Focusing strategies on barriers related to capability and opportunity such as online/telephone support, mobile screening programs and financial assistance for screeners may better enhance screening participation. Providing funding for clinicians to support individuals in decision-making and belief in self-efficacy may foster motivation. Targeting interventions that connect eligible individuals with the LCS program will be crucial for successful implementation.

Facilitators and Barriers to Lung Cancer Screening during Long COVID: A Global Systematic Review and Meta-Study Synthesis of Qualitative Research

“…It was integral in overcoming other reported cultural, social, and structural or organizational policy barriers to screening. In our review, participants' lack of awareness of lung cancer screening was frequently reported, i.e., in 17 articles [28,[30][31][32][33][36][37][38][39]41,44,45,48,50,[57][58][59]. Participants often had not heard of lung cancer or chose not to be screened due to fear of a cancer diagnosis or concerns about cost, which affected their attitudes about lung cancer and their motivation to participate in lung cancer screening.…”

“…Individual and interpersonal facilitators. Studies showed that individuals who were aware of early detection lung cancer screening [21][22][23][24][25][26][27][28][29][30][31], high perceived benefit [30,[42][43][44], motivation to quit smoking [32,33,38,45], provision of the mobile testing program and home test kits during COVID-19 [46], enthusiasm for lung cancer [28,[32][33][34]38,42,43,45,[47][48][49][50], a screening recommendation from a healthcare provider [30,33,38,45,51], and shared decisionmaking interaction between discussion [31,[52][53][54] were more supportive of screening and tended to be screened Table S1.…”

“…Individual and interpersonal barriers. Studies showed that low awareness of lung screening [28,[30][31][32][33][36][37][38][39]41,44,45,48,50,[57][58][59], fear of cancer diagnosis, and worry [31][32][33][36][37][38]40,43,[45][46][47][48]54,58,60,61], low perceived benefit (feeling healthy) [30,37,48,62], concern or high perceived risk of LDCT [28,33,34,38,41,42,44,45,47,49,60], COVID-19 fear (perceptions of risk, mortality, worry, behavioral and psychosocial responses to COVID-19) [61,…”

“What do I think about implementing lung cancer screening? It all depends on how.” Acceptability and feasibility of lung cancer screening in Australia: The view of key stakeholders about health system factors

“…We acknowledge that the resulting data do not reflect the perceptions of LCS participants. Our team has recently published a study of Australian participants in the International Lung Screening Trial, which found that individual PLOS ONE motivation to screen must be accompanied by strategies that enable opportunities and enhance individual's capabilities to screening for lung cancer [43]. Furthermore, our team is currently undertaking research to explore patient perceptions of barriers and facilitators to LCS program in focus groups with a diverse range of culturally diverse community members.…”

“We need to work towards it, whatever it takes.”—participation factors in the acceptability and feasibility of lung cancer screening in Australia: the perspectives of key stakeholders

“…Previous research has shown reduced uptake of cancer screening consistently in underserved populations ( 26 - 28 ) and so demonstrates the need for newly implemented cancer screening programs to address the barriers to uptake in these populations from the early stages of planning a program. A recent Australian study examined participation factors in the International Lung Screening Trial using the COM-B model of behaviour change, citing capability, opportunity and motivation as factors to change behaviour ( 29 ). This study found that motivation alone may not be sufficient to change behaviour related to screening participation, unless capability (e.g., enhance people’s knowledge) and opportunity (e.g., convenient locations) are considered.…”