Patient Perspectives on Longitudinal Adherence to Lung Cancer Screening

Holman, Anna; Kross, Erin K.; Crothers, Kristina; Cole, Allison; Wernli, Karen J.; Triplette, Matthew

doi:10.1016/j.chest.2022.01.054

Cited by 14 publications

(9 citation statements)

References 23 publications

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“…Access and equity was a key theme that emerged from this data from focus groups conducted with health professionals across Australia, with it strongly advocated that strategies are needed to ensure immediate equitable access, as the success of the program would be dependent on it. Access as a barrier, particularly travel, has been commonly reported in previous research in initial screening of multiple cohorts ( 30 , 33 , 34 ). Suggestions by the health professionals in this study to facilitate access and equity included mobile screening vans to reach rural and remote communities such as those used in the UK pilot screening trials.…”

Section: Discussionmentioning

confidence: 94%

“…In the US, a decade has passed since implementation first began. Although practical and financial barriers to screening continue to be significant, most LCS participants have reported screening as acceptable, non-invasive and relatively easy to engage in ( 30 ). However, we know very little about what healthcare providers consider to be the barriers and enablers that will impact on LCS participation in Australia.…”

Section: Introductionmentioning

confidence: 99%

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“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

Dodd,

Sharman,

Yap

et al. 2024

Transl Lung Cancer Res

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Background Low dose computed tomography (LDCT) screening, targeted at those at high-risk, has been shown to significantly reduce lung cancer mortality and detect cancers at an early stage. Practical, attitudinal and demographic factors can inhibit screening participation in high-risk populations. This study aimed to explore stakeholders’ views about barriers and enablers (determinants) to participation in lung cancer screening (LCS) in Australia. Methods Twenty-four focus groups (range 2–5 participants) were conducted in 2021 using the Zoom platform. Participants were 84 health professionals, researchers, policy makers and program managers of current screening programs. Focus groups consisted of a structured presentation with facilitated discussion lasting about 1 hour. The content was analysed thematically and mapped to the Consolidated Framework for Implementation Research (CFIR). Results Screening determinants were identified across each stage of the proposed screening and assessment pathway. Challenges included participant factors such as encouraging participation for individuals at high-risk, whilst ensuring that access and equity issues were carefully considered in program design. The development of awareness campaigns that engaged LCS participants and health professionals, as well as streamlined referral processes for initial entry and follow-up, were strongly advocated for. Considering practical factors included the use of mobile vans in convenient locations. Conclusions Participants reported that LCS in Australia was acceptable and feasible. Participants identified a complex set of determinants across the proposed screening and assessment pathway. Strategies that enable the best chance for program success must be identified prior to implementation of a national LCS program.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

“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

Dodd,

Sharman,

Yap

et al. 2024

Transl Lung Cancer Res

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“…Similar to other studies, we found that Veterans commonly trusted and deferred to clinician recommendations. 13,31,32 Patients' reliance on clinician recommendations has important implications, especially given that clinicians often lack knowledge regarding further evaluations in the LCS continuum, seldom incorporate shared decision-making tools, and are unsure how to incorporate life expectancy into screening decisions. 30,[33][34][35][36] Given insufficient time and competing demands during clinical visits, clinicians might offer little information to patients on LCS harms and the longitudinal LCS process.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 In general, patients often recall discussing benefits but not harms of LCS with clinicians. 12,13 Little is known about the perspectives of patients with multiple comorbidities and limited life expectancy, or what considerations factor into their decision making regarding LCS. Exploring these perspectives is key to understanding the discrepancy between guideline recommendations and LCS uptake in this population with limited net benefit from screening.…”

Section: Introductionmentioning

confidence: 99%

“It Can’t Hurt!”: Why Many Patients With Limited Life Expectancy Decide to Accept Lung Cancer Screening

Núñez,

Bolton,

Boudreau

et al. 2024

Ann Fam Med

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PURPOSE Lung cancer screening (LCS) has less benefit and greater potential for iatrogenic harm among people with multiple comorbidities and limited life expectancy. Yet, such individuals are more likely to undergo screening than healthier LCS-eligible people. We sought to understand how patients with marginal LCS benefit conceptualize their health and make decisions regarding LCS. METHODSWe interviewed 40 people with multimorbidity and limited life expectancy, as determined by high Care Assessment Need scores, which predict 1-year risk of hospitalization or death. Patients were recruited from 6 Veterans Health Administration facilities after discussing LCS with their clinician. We conducted a thematic analysis using constant comparison to explore factors that influence LCS decision making. RESULTSPatients commonly held positive beliefs about screening and perceived LCS to be noninvasive. When posed with hypothetical scenarios of limited benefit, patients emphasized the nonlongevity benefits of LCS (eg, peace of mind, planning for the future) and generally did not consider their health status or life expectancy when making decisions regarding LCS. Most patients were unaware of possible additional evaluations or treatment of screendetected findings, but when probed further, many expressed concerns about the potential need for multiple evaluations, referrals, or invasive procedures.CONCLUSIONS Patients in this study with multimorbidity and limited life expectancy were unaware of their greater risk of potential harm when accepting LCS. Given patient trust in clinician recommendations, it is important that clinicians engage patients with marginal LCS benefit in shared decision making, ensuring that their values of desiring more information about their health are weighed against potential harms from further evaluations.

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“…We would argue that it may be the programmatic elements of patient navigation that can have the largest impact on mitigating disparities along the screening care continuum. Unmet social determinants of health (e.g., underinsurance, housing insecurity, and transportation) have been shown to be key reasons for having missed an LCS evaluation ( 13 , 14 ). Patient navigation can generally be thought of as a set of patient-facing interventions to assist patients in overcoming barriers in a care process.…”

mentioning

confidence: 99%

Addressing Lung Cancer Screening Disparities: What Does It Mean to Be Centralized?

Núñez

Triplette

2022

Annals ATS

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Patient Perspectives on Longitudinal Adherence to Lung Cancer Screening

Cited by 14 publications

References 23 publications

“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

“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

“It Can’t Hurt!”: Why Many Patients With Limited Life Expectancy Decide to Accept Lung Cancer Screening

Addressing Lung Cancer Screening Disparities: What Does It Mean to Be Centralized?

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