A Qualitative Study Exploring Why Individuals Opt Out of Lung Cancer Screening

Background. Lung cancer screening with annual low-dose computed tomography is relatively new for long-term smokers in the USA supported by a US Preventive Services Task Force Grade B recommendation. As screening programs are more widely implemented nationally and providers engage patients about lung cancer screening, it is critical to understand behaviour among high-risk smokers who opt out to improve shared decision-making processes for lung cancer screening. Objective. The purpose of this study was to explore the reasons for screening-eligible patients’ decisions to opt out of screening after receiving a provider recommendation. Methods. Semi-structured qualitative telephone interviews were performed with 18 participants who met lung cancer screening criteria for age, smoking and pack-year history in Washington State from November 2015 to January 2016. Two researchers with cancer screening and qualitative methodology expertise conducted data analysis using thematic content analytic procedures from audio-recorded interviews. Results. Five primary themes emerged for reasons of opting out of lung cancer screening: (i) Knowledge Avoidance; (ii) Perceived Low Value; (iii) False-Positive Worry; (iv) Practical Barriers; and (v) Patient Misunderstanding. Conclusion. The participants in our study provided insight into why some patients make the decision to opt out of low-dose computed tomography screening, which provides knowledge that can inform intervention development to enhance shared decision-making processes between long-term smokers and their providers and decrease decisional conflict about screening

Women’s experiences and preferences regarding breast imaging after completing breast cancer treatment

After treatment for breast cancer, most women receive an annual surveillance mammography to look for subsequent breast cancers. Supplemental breast MRI is sometimes used in addition to mammography despite the lack of clinical evidence for it. Breast imaging after cancer treatment is an emotionally charged experience, an important part of survivorship care, and a topic about which limited patient information exists. We assessed women’s experiences and preferences about breast cancer surveillance imaging with the goal of determining where gaps in care and knowledge could be filled

Women’s experiences and preferences regarding breast imaging after completing breast cancer treatment

Background: After treatment for breast cancer, most women receive an annual surveillance mammography to look for subsequent breast cancers. Supplemental breast MRI is sometimes used in addition to mammography despite the lack of clinical evidence for it. Breast imaging after cancer treatment is an emotionally charged experience, an important part of survivorship care, and a topic about which limited patient information exists. We assessed women’s experiences and preferences about breast cancer surveillance imaging with the goal of determining where gaps in care and knowledge could be filled. Participants and methods We conducted six focus groups with a convenience sample of 41 women in California, North Carolina, and New Hampshire (USA). Participants were aged 38–75 years, had experienced stage 0–III breast cancer within the previous 5 years, and had completed initial treatment. We used inductive thematic analysis to identify key themes from verbatim transcripts. Results: Women reported various types and frequencies of surveillance imaging and a range of surveillance imaging experiences and preferences. Many women experienced discomfort during breast imaging and anxiety related to the examination, primarily because they feared subsequent cancer detection. Women reported trust in their providers and relied on providers for imaging decision-making. However, women wanted more information about the treatment surveillance transition to improve their care. Conclusion: There is significant opportunity in breast cancer survivorship care to improve women’s understanding about breast cancer surveillance imaging and to provide enhanced support to them at the time their initial treatment ends and at the time of surveillance imaging examinations

Lung Cancer Screening: A Qualitative Study Exploring the Decision to Opt Out of Screening

Background: Lung cancer screening with annual low-dose computed tomography is relatively new for long-term smokers in the United States, and supported by a U.S. Preventive Services Task Force Grade B recommendation. As lung cancer screening programs are more widely implemented and providers engage patients about screening, it is critical to understand what influences a patient’s decision to screen, or not, for lung cancer. Understanding lung cancer screening behavior among high-risk smokers who opt out provides insight from the patient perspective about the shared decision-making process for lung cancer screening. The purpose was to explore screening-eligible patients’ decision to opt out of lung cancer screening after receiving a provider recommendation. This knowledge will inform intervention development to enhance shared decision-making processes between long-term smokers and their providers and decrease decisional conflict about lung cancer screening. Methods: Semi-structured qualitative telephone interviews were performed with 18 lung screening-eligible men and women who were members of an integrated, mixed-model health care system in Seattle, Washington, about their decision to opt out of lung cancer screening. Participants met lung cancer screening criteria for age, smoking and pack-year history. Audio-recorded interviews were transcribed verbatim. Two researchers with cancer screening and qualitative methodology expertise conducted data analysis using thematic content analytic procedures. Results: Participant mean age was 66 years (standard deviation: 6.5). Majority were female (61%), Caucasian (83%) or current smokers (61%). Five themes emerged: 1) Knowledge Avoidance; 2) Perceived Low Value; 3) False-Positive Worry; 4) Practical Barriers; and 5) Patient Misunderstanding. Conclusion: Many screening-eligible smokers opt out of lung cancer screening. The participants in our study provided new insights into why some patients make this choice. While there are known drawbacks to lung cancer screening, and it is not necessarily the best option for everyone who is eligible, it is known to be effective in early lung cancer detection among high-risk patients. Understanding why people decide not to screen will enhance future efforts to improve knowledge transfer from providers to patients about the risks and benefits of lung cancer screening and ultimately enhance shared decision-making about lung cancer screening

Study participant socio-demographic characteristics and smoking history.

<p>Patient-level characteristics are linked in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0196758#pone.0196758.s002" target="_blank">S1 Table</a>.</p

Sample items from the semi-structured interview guide.

<p>The full semi-structured interview guide is linked in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0196758#pone.0196758.s001" target="_blank">S1 File</a>.</p

Major study themes and example quotes.

<p>All quotes supporting each theme are linked in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0196758#pone.0196758.s003" target="_blank">S2 Table</a>.</p

A qualitative study exploring patient motivations for screening for lung cancer

<div><p>Background</p><p>Low-dose computed tomography (LDCT) of the chest for lung cancer screening of heavy smokers was given a ‘B’ rating by the U.S. Preventive Services Task Force (USPSTF) in 2013, and gained widespread insurance coverage in the U.S. in 2015. Lung cancer screening has since had low uptake. However, for those that do choose to screen, little is known about patient motivations for completing screening in real-world practice.</p><p>Objective</p><p>To explore the motivations for screening-eligible patients to screen for lung cancer.</p><p>Methods</p><p>Semi-structured qualitative interviews were conducted with 20 LDCT screen-completed men and women who were members of an integrated mixed-model healthcare system in Washington State. From June to September 2015, participants were recruited and individual interviews performed about motivations to screen for lung cancer. Audio-recorded interviews were transcribed and analyzed using inductive content analysis by three investigators.</p><p>Results</p><p>Four primary themes emerged as motivations for completing LDCT lung cancer screening: 1) trust in the referring clinician; 2) early-detection benefit; 3) low or limited harm perception; and 4) friends or family with advanced cancer.</p><p>Conclusion</p><p>Participants in our study were primarily motivated to screen for lung cancer based on perceived benefit of early-detection, absence of safety concerns, and personal relationships. Our findings provide new insights about patient motivations to screen, and can potentially be used to improve lung cancer screening uptake and shared decision-making processes.</p></div