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

Background Although new screening programmes with low-dose computed tomography (LDCT) for lung cancer have been implemented throughout the United States, screening uptake remains low and screening-eligible persons' decisions to screen or not remain poorly understood. Objective To describe how current and former long-term smokers explain their decisions regarding participation in lung cancer screening. Design Phone interviews using a semi-structured interview guide were conducted to ask screening-eligible persons to describe their decisions regarding screening with LDCT. The interviews were transcribed and analysed with conventional content analytic techniques. Setting and participants A subsample of 40 participants (20 who had screened and 20 who had not) were drawn from the sample of a survey study whose participants were recruited by Facebook targeted advertisements. Results The sample was divided into the following five groups based on their decisions regarding lung cancer screening participation: Group 1: no intention to be screened, Group 2: no deliberate consideration but somewhat open to being screened, Group 3: deliberate consideration but no definitive decision to be screened, Group 4: intention to be screened and Group 5: had been screened. Reasons for screening participation decisions are described for each group. Across groups, data revealed that screening-eligible persons have a number of misconceptions regarding LDCT, including that a scan is needed only if one is symptomatic or has not had a chest x-ray. A physician recommendation was a key influence on decisions to screen. Discussion and conclusions Education initiatives aimed at providers and long-term smokers regarding LDCT is needed. Quality patient/provider communication is most likely to improve screening rates.