Lung cancer screening experiences among patients with a smoking history and primary care providers: a qualitative study

Abstract

Background: Lung cancer screening (LCS) with low dose CT can identify early-stage lung cancer and reduce lung cancer mortality. LCS is underutilized. Patient and provider concerns and experiences may contribute to low utilization.

Objective: To categorize patient and provider experiences with lung cancer screening to identify barriers to utilization.

Design: Mixed methods study with a survey plus a qualitative interview.

Participants: Participants were 50 patients aged 55-80 with a smoking history and 7 primary care physicians in the United States.

Methods: Participants were interviewed about LCS perceptions and experiences. Transcripts were double-coded and an Applied Thematic Analysis identified key themes.

Results: Thirty-two patients (68% of those with valid data) met US Preventive Services Taskforce guideline criteria for lung cancer screening, 11 (22%) self-reported tests consistent with LCS. Five main themes emerged: (1) Patient knowledge about LCS is low, even among those screened. Provider knowledge is high. (2) Low dose CT for LCS is well tolerated by patients and acceptable to providers. (3) Provider behavior is influenced by public health guidelines but not insurance coverage. (4) Shared decision-making is not always engaged in. (5) System barriers in the referral process affect LCS receipt despite patient interest in LCS.

Conclusions: LCS is well tolerated by patients and valued by providers. To increase LCS knowledge and uptake, systems changes are needed to facilitate shared decision-making conversations, simplify the referral process, and provide care navigation to increase patient logistical barriers to uptake.

Keywords: Decision making, shared; Early detection of cancer; Health knowledge, attitudes, practice; Healthcare disparities; Lung neoplasms; Primary health care.