Determinants of Lung Cancer Screening in a Minnesota Urban Indigenous Community: A Community-Based, Participatory, Action-Oriented Study

Abstract

Although lung cancer screening (LCS) with annual low-dose chest CT has been shown to reduce lung cancer deaths, it remains underutilized. Northern Plains American Indian and Alaska Native (AI/AN) communities experience extreme lung cancer disparities, and little is known about the acceptance and adoption of LCS in these groups. We conducted interviews with healthcare professionals and focus groups with patients in an urban Minnesota community clinic serving AI/AN. Data collection took place during winter 2019-2020. Indigenous researchers collected and analyzed the data for emergent themes using simultaneous collaborative consensus with a LCS researcher. Participants reported some similar barriers to LCS as previous studies reported but also shared some new insights into traditional ways of knowing and recommendations for effectively implementing this evidence-based preventive care service. Lung screening is largely acceptable to patients and healthcare personnel in an AI/AN-serving community clinic. We identified barriers as previously reported in other populations but also identified some unique barriers and motivators. For example, the concept of the seven generations may provide motivation to maintain one's health for future generations while providing additional support during screening for persons traumatized by the Western medicine health system may facilitate increased screening uptake.

Prevention relevance: Secondary prevention of lung cancer through screening is potentially lifesaving considering that overall survival of lung cancer is 20% at 5 years but curable if detected at an early stage. This work provides insight into culturally tailored approaches to implementing the service in individuals at high risk of the disease.