Understanding the decision to screen for lung cancer or not: A qualitative analysis

Draucker, Claire Burke; Rawl, Susan M.; Vode, Emilee; Carter‐Harris, Lisa

doi:10.1111/hex.12975

Cited by 17 publications

(39 citation statements)

References 22 publications

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“…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.…”

Section: Connecting In a Study Of Lung Cancer Screeningmentioning

confidence: 99%

“…Interview participants were asked to describe their decisions regarding screening with LDCT as well as to discuss some of their responses on the quantitative survey in greater depth. Initial results of this strand of the study have been published (Draucker et al, 2019). In summary, a content analysis of the interview transcripts revealed that the interview participants’ screening decisions ranged from firm decisions not to screen because they deemed it to be a waste of time to enthusiastic decisions to screen because they believed screening was essential to their health and well-being.…”

Section: Connecting In a Study Of Lung Cancer Screeningmentioning

confidence: 99%

“…In summary, a content analysis of the interview transcripts revealed that the interview participants’ screening decisions ranged from firm decisions not to screen because they deemed it to be a waste of time to enthusiastic decisions to screen because they believed screening was essential to their health and well-being. The findings also revealed that receiving a healthcare provider recommendation was a key factor in a decision to screen and that many participants had a number of misconceptions regarding LDCT, including that a scan is needed only if one is symptomatic or had not had a chest x-ray (Draucker et al, 2019).…”

Section: Connecting In a Study Of Lung Cancer Screeningmentioning

confidence: 99%

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Integration Through Connecting in Explanatory Sequential Mixed Method Studies

et al. 2020

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The purposes of this methods article are to (a) discuss how integration can occur through a connecting approach in explanatory sequential mixed methods studies, (b) describe a connecting strategy developed for a study testing a conceptual model to predict lung cancer screening, and (c) describe three analytic products developed by subsequent integration procedures enabled by the connecting strategy. Connecting occurs when numeric data from a quantitative strand of a study are used to select a sample to be interviewed for a subsequent qualitative strand. Because researchers often do not fully exploit numeric data for this purpose, we developed a multi-step systematic sampling strategy that produced an interview sample of eight subgroups of five persons ( n = 40) whose profiles converged with or diverged from the conceptual model in specified ways. The subgroups facilitated the development of tailored interview guides, in-depth narrative summaries, and exemplar case studies to expand the quantitative findings.

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Section: Connecting In a Study Of Lung Cancer Screeningmentioning

confidence: 99%

Section: Connecting In a Study Of Lung Cancer Screeningmentioning

confidence: 99%

Section: Connecting In a Study Of Lung Cancer Screeningmentioning

confidence: 99%

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Integration Through Connecting in Explanatory Sequential Mixed Method Studies

et al. 2020

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“…Relatively few studies have sought to understand individuals' motivation for participating in lung cancer screening 55 . A model to conceptualize the multiple variables that may influence screening uptake is presented in Figure 1 and provides an understanding of how best to encourage screening participation 56 . Screening motivation may be more important in lung cancer than other cancer screening programmes because the target population is current and former smokers, many of whom may be reluctant users of health services, may have poor health literacy and be disinterested in engaging in healthy lifestyle activities 48,57 …”

Section: Attitudes and Motivationmentioning

confidence: 99%

“…Conceptual model for lung cancer screening participation (Reproduced from Draucker et al ., 56 with permission).…”

Section: Attitudes and Motivationmentioning

confidence: 99%

Lung cancer screening implementation: Complexities and priorities

2020

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Lung cancer is the number one cause of cancer death worldwide. The benefits of lung cancer screening to reduce mortality and detect early‐stage disease are no longer in any doubt based on the results of two landmark trials using LDCT. Lung cancer screening has been implemented in the US and South Korea and is under consideration by other communities. Successful translation of demonstrated research outcomes into the routine clinical setting requires careful implementation and co‐ordinated input from multiple stakeholders. Implementation aspects may be specific to different healthcare settings. Important knowledge gaps remain, which must be addressed in order to optimize screening benefits and minimize screening harms. Lung cancer screening differs from all other cancer screening programmes as lung cancer risk is driven by smoking, a highly stigmatized behaviour. Stigma, along with other factors, can impact smokers' engagement with screening, meaning that smokers are generally ‘hard to reach’. This review considers critical points along the patient journey. The first steps include selecting a risk threshold at which to screen, successfully engaging the target population and maximizing screening uptake. We review barriers to smoker engagement in lung and other cancer screening programmes. Recruitment strategies used in trials and real‐world (clinical) programmes and associated screening uptake are reviewed. To aid cross‐study comparisons, we propose a standardized nomenclature for recording and calculating recruitment outcomes. Once participants have engaged with the screening programme, we discuss programme components that are critical to maximize net benefit. A whole‐of‐programme approach is required including a standardized and multidisciplinary approach to pulmonary nodule management, incorporating probabilistic nodule risk assessment and longitudinal volumetric analysis, to reduce unnecessary downstream investigations and surgery; the integration of smoking cessation; and identification and intervention for other tobacco related diseases, such as coronary artery calcification and chronic obstructive pulmonary disease. National support, integrated with tobacco control programmes, and with appropriate funding, accreditation, data collection, quality assurance and reporting mechanisms will enhance lung cancer screening programme success and reduce the risks associated with opportunistic, ad hoc screening. Finally, implementation research must play a greater role in informing policy change about targeted LDCT screening programmes.

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Factors Associated With Declining Lung Cancer Screening After Discussion With a Clinician in a Cohort of US Veterans

et al. 2022

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ImportanceLung cancer screening (LCS) is underused in the US, particularly in underserved populations, and little is known about factors associated with declining LCS. Guidelines call for shared decision-making when LCS is offered to ensure informed, patient-centered decisions.ObjectiveTo assess how frequently veterans decline LCS and examine factors associated with declining LCS.Design, Setting, and ParticipantsThis retrospective cohort study included LCS-eligible US veterans who were offered LCS between January 1, 2013, and February 1, 2021, by a physician at 1 of 30 Veterans Health Administration (VHA) facilities that routinely used electronic health record clinical reminders documenting LCS eligibility and veterans’ decisions to accept or decline LCS. Data were obtained from the Veterans Affairs (VA) Corporate Data Warehouse or Medicare claims files from the VA Information Resource Center.Main Outcomes and MeasuresThe main outcome was documentation, in clinical reminders, that veterans declined LCS after a discussion with a physician. Logistic regression analyses with physicians and facilities as random effects were used to assess factors associated with declining LCS compared with agreeing to LCS.ResultsOf 43 257 LCS-eligible veterans who were offered LCS (mean [SD] age, 64.7 [5.8] years), 95.9% were male, 84.2% were White, and 37.1% lived in a rural zip code; 32.0% declined screening. Veterans were less likely to decline LCS if they were younger (age 55-59 years: odds ratio [OR], 0.69; 95% CI, 0.64-0.74; age 60-64 years: OR, 0.80; 95% CI, 0.75-0.85), were Black (OR, 0.80; 95% CI, 0.73-0.87), were Hispanic (OR, 0.62; 95% CI, 0.49-0.78), did not have to make co-payments (OR, 0.92; 95% CI, 0.85-0.99), or had more frequent VHA health care utilization (outpatient: OR, 0.70; 95% CI, 0.67-0.72; emergency department: OR, 0.86; 95% CI, 0.80-0.92). Veterans were more likely to decline LCS if they were older (age 70-74 years: OR, 1.27; 95% CI, 1.19-1.37; age 75-80 years: OR, 1.93; 95% CI, 1.73-2.17), lived farther from a VHA screening facility (OR, 1.06; 95% CI, 1.03-1.08), had spent more days in long-term care (OR, 1.13; 95% CI, 1.07-1.19), had a higher Elixhauser Comorbidity Index score (OR, 1.04; 95% CI, 1.03-1.05), or had specific cardiovascular or mental health conditions (congestive heart failure: OR, 1.25; 95% CI, 1.12-1.39; stroke: OR, 1.14; 95% CI, 1.01-1.28; schizophrenia: OR, 1.87; 95% CI, 1.60-2.19). The physician and facility offering LCS accounted for 19% and 36% of the variation in declining LCS, respectively.Conclusions and RelevanceIn this cohort study, older veterans with serious comorbidities were more likely to decline LCS and Black and Hispanic veterans were more likely to accept it. Variation in LCS decisions was accounted for more by the facility and physician offering LCS than by patient factors. These findings suggest that shared decision-making conversations in which patients play a central role in guiding care may enhance patient-centered care and address disparities in LCS.

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Understanding the decision to screen for lung cancer or not: A qualitative analysis

Cited by 17 publications

References 22 publications

Integration Through Connecting in Explanatory Sequential Mixed Method Studies

Integration Through Connecting in Explanatory Sequential Mixed Method Studies

Lung cancer screening implementation: Complexities and priorities

Factors Associated With Declining Lung Cancer Screening After Discussion With a Clinician in a Cohort of US Veterans

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