Understanding lung cancer screening behaviour using path analysis

Abstract

Objective Understanding lung cancer screening behaviour is crucial to identifying potentially modifiable factors for future intervention. Qualititative work has explored attitudes and beliefs about lung cancer screening from the perspective of the participant, but the theoretically grounded factors that influence screening-eligible individuals to screen are unknown. We tested an explanatory framework for lung cancer screening participation from the individual’s perspective. Methods Data were collected as part of a sequential explanatory mixed methods study, the quantitative component of which is reported here. A national purposive sample of 515 screening-eligible participants in the United States was recruited using Facebook-targeted advertisement. Participants completed surveys assessing constructs of the Conceptual Model for Lung Cancer Screening Participation. Path analysis was used to assess the relationships between variables. Results Path analyses revealed that a clinician recommendation to screen, higher self-efficacy scores, and lower mistrust scores were directly associated with screening participation (p < 0.05). However, the link between screening behaviour and self-efficacy appeared to be fully mediated by fatalism, lung cancer fear, lung cancer family history, knowledge of lung cancer risk and screening, income, clinician recommendation, and social influence (p < 0.05). Conclusions This study found that medical mistrust, self-efficacy, and clinician recommendation were significant in the decision of whether to screen for lung cancer. These findings offer insight into potentially modifiable targets most appropriate on which to intervene. This understanding is critical to design meaningful clinician- and patient-focused interventions.

Integration Through Connecting in Explanatory Sequential Mixed Method Studies

“…The lung cancer screening study (Carter-Harris et al, 2019; Draucker et al, 2019) conducted by our research team (referred to as the parent study) is first briefly summarized to provide the context for the discussion that follows describing the strategy we developed to select the interview sample. All strands of the parent study received approval from the Institutional Review Board (IRB) of the investigators’ institution.…”

“…A sample of 515 persons in the United States who currently or formerly smoked long-term and who were eligible for lung cancer screening per the United States Preventive Services Task Force (USPSTF) guidelines (American Cancer Society, 2016) (hereafter referred to as survey participants) were recruited by nationwide Facebook targeted advertisements. The conceptual model and the findings of the path analysis have been published (Carter-Harris et al, 2019). In summary, the path analysis revealed that a healthcare provider recommendation to screen, higher self-efficacy, and lower medical mistrust were directly associated with screening participation ( p < .05).…”

Lung cancer screening and stigma: Do smoking-related differences in perceived lung cancer stigma emerge prior to diagnosis?

“…Participants provided informed consent; all procedures were approved by the Institutional Review Board at Indiana University prior to participant recruitment. This study reports secondary analyses from a larger study on lung cancer screening; additional details on the sample and recruitment have been reported previously (Carter-Harris et al, 2019).…”

Health Disparity in Effective Cervical Cancer Screening: Findings from a National Survey of U.S.

“…The engagement of users as information sources in social media greatly promotes the communication of health information. However, when compared with patient-provider professional health communication [36,49], interpersonal communication via the Internet and social media made a signi cant difference in women's effective screening behavior. Those who attempt to search for screening information through social media or are exposed to the communication of such screening information may be unable to choose advice appropriate and therefore have experienced ineffective CCS.…”