Examining the smokescreen: Patient and provider attitudes and practices around lung cancer screening – a formative study

The scientific community lacks conclusive evidence for the effectiveness of lung cancer screening in the early detection of disease. The potential benefit of an effective screening test is to detect lung cancer at a less advanced stage when treatments may be more effective. While studies have shown chest x-ray to be ineffective for early detection and reduced mortality, research is underway to assess the efficacy of CT technology in reducing lung cancer morbidity and mortality. While the scientific community awaits the results of key clinical trials, public health officials need to better understand physician practices and health care consumers' experiences in the area of lung cancer screening.

To address this need, the Centers for Disease Control and Prevention (CDC) and Research Triangle Institute (RTI) conducted a formative study with primary care physicians and heavy smokers. We used qualitative methods to address the following research questions: (1) What are physicians' knowledge and attitudes about lung cancer screening guidelines? (2) What are smokers' and physicians' attitudes toward and experiences with screening tests and with lung cancer screening in particular? (3) How do physicians identify candidates for lung cancer screening? (4) What do physicians tell their patients about lung cancer screening tests? (5) What challenges do heavy smokers face in quitting smoking? The study was approved by institutional review boards at both CDC and RTI International.

We conducted 12, two-hour, in-person focus groups with consumers (n=107) in Charlotte, NC and Cincinnati, OH, all of whom were long-term smokers, and five 75-minute telephone-based focus groups with primary care physicians from across the U.S. (n= 28). Consumer groups were segmented by gender and physician groups were segmented based on whether they refer patients who smoke for lung cancer screening. All groups were professionally moderated and audio recorded. A detailed codebook was developed and verbatim transcripts were coded using a qualitative software program. Other standard qualitative analysis techniques were applied.

In this session we will present the study findings and make recommendations for practice and research. Results suggest that some physicians are not fully aware of current screening guidelines. Physician's who referred non-symptomatic individuals for screening did so based on a patient's smoking history, patient request, and liability concerns. Insurance coverage influenced physicians' decisions to refer patients for screening. Smokers had little to no knowledge about the availability or types of lung cancer screening and demonstrated significant denial about their personal risk to develop lung cancer.