Patients' Attitudes Regarding Lung Cancer Screening and Decision Aids. A Survey and Focus Group Study

Abstract

Rationale: Little is known about vulnerable patients' perceptions and understanding of, and preferences for, lung cancer screening decision aids.

Objectives: To determine, in a low-income, racially diverse population, (1) participants' experience, preferences, and reactions to web-based and paper decision aids, and (2) their understanding of harms and benefits of lung cancer screening.

Methods: We enrolled outpatients at an urban county hospital in six focus group discussions that included review of a web-based and a paper-based lung-cancer screening decision aid. Participants completed surveys before and after the focus groups.

Measurements and main results: Forty-five patients participated (mean age, 61 yr; 76% current smokers; 24% former smokers); 27% had not completed high school; 50% had an annual income not exceeding $15,000; 42% were nonwhite; and 96% reported chronic illness requiring at least three health care visits yearly. Comparing the proportion with correct answers on pre- and postsurveys, participants' understanding of lung cancer screening increased, particularly of the harms of screening including the potential for false positives, extra testing, and complications. However, after conclusion of the focus groups, more than 50% believed that screening lowered the chance of getting lung cancer. Five major themes emerged from qualitative analyses. Participants (1) were not aware of the purpose of lung cancer screening; (2) wanted to know about the benefits and harms; (3) believed physicians need to communicate more effectively; (4) found decision aids helpful and influential for decision-making about screening; and (5) wanted the discussion to be personalized and tailored. Participants expressed surprise that the magnitude of their lung cancer risk and benefits of screening were lower than anticipated.

Conclusions: Vulnerable patients find lung cancer screening decision aids helpful and generally show increased knowledge after reviewing decision aids, particularly of harms. Our results can inform future implementation efforts.

Keywords: decision support techniques; early detection of cancer; health care disparities; lung neoplasms; qualitative research.