Perspectives of family physicians towards access to lung cancer screening for individuals living with low income – a qualitative study

Abstract

Background Individuals living with low income are less likely to participate in lung cancer screening (LCS) with low-dose computed tomography. Family physicians (FPs) are typically responsible for referring eligible patients to LCS; therefore, we sought to understand their perspectives on access to lung cancer screening for individuals living with low income in order to improve equity in access to LCS. Methods A theory-informed thematic analysis was conducted using data collected from 11 semi-structured interviews with FPs recruited from three primary care sites in downtown Toronto. Data was coded using the Systems Model of Clinical Preventative Care as a framework and interpretation was guided by the synergies of oppression analytical lens. Results Four overarching themes describe FP perspectives on access to LCS for individuals living with low income: the degree of social disadvantage that influences lung cancer risk and opportunities to access care; the clinical encounter, where there is often a mismatch between the complex health needs of low income individuals and structure of health care appointments; the need for equity-oriented health care, illustrated by the neglect of structural origins of health risk and the benefits of a trauma-informed approach; and finally, the multiprong strategies that will be needed in order to improve equity in health outcomes. Conclusion An equity-oriented and interdisciplinary team based approach to care will be needed in order to improve access to LCS, and attention must be given to the upstream determinants of lung cancer in order to reduce lung cancer risk.

Advancing health equity in cancer care: The lived experiences of poverty and access to lung cancer screening

“…In Canada, physicians are gatekeepers to and proponents of lung cancer screening and therefore have a critical role in ensuring equitable healthcare delivery. We have described physician perspectives on access to lung cancer screening for individuals living with low income elsewhere; a key finding was that an equity-oriented approach and attention to the upstream determinants of lung cancer by physicians will be needed in order to improve equitable access to lung cancer screening [ 34 ]. Our findings suggest that physicians and other healthcare practitioners must learn how to deliver care that is free of personal biases to prevent the perpetuation of oppression and the systemic reproduction of health inequities.…”

The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives—State of the Art

“…Even in high-income countries, patients with a lower level of income and education are less likely to participate in preventative health checks as cancer screening. However, due to more bad lifestyle habits in this disadvantaged population, a higher incidence of lung cancer is found [169]. In addition, the cost of surgical treatment varies depending on the patient's demographic background and medical history, as well as the costs associated with the occurrence of adverse post-operative events.…”

Toward Equity-oriented Cancer Care: a Strategy for Patient-oriented Research (SPOR) Protocol to Promote Equitable Access to Lung Cancer Screening.

“…On the other hand, the provision of care that is stigmatizing, lacks self-re exivity and perpetuates personal and systemic biases can create unsafe spaces that discourage participation in LCS (17). In Canada, this is of heightened importance as family physicians are gatekeepers to LCS (5) and other primary and community care providers such as nurse practioners, nurses, social workers, dieticians, community and peer support workers, health promoters, and occupational therapists are strategically placed to provide the wrap around support services that can enable timely referrals by physicians (24).…”

“…Our work to date has demonstrated a disconnect between the needs and priorities of individuals who are at a high-risk of developing lung cancer (17) and the perceptions of need and clinical care imparted by primary care providers, particularly for individuals living in marginalizing social conditions (24). Programs that support decision making for cancer care including screening, and policies that support the timely adoption of ndings that seek to reduce inequities in care for priority populations are strategic priorities for the American Association of Cancer Research (18) and the Canadian Institutes of Health Research (CIHR) Institute for Cancer Research (19).…”