Knowledge and attitudes of lung cancer screening in a high-risk, rural population

Introduction: Kentucky suffers the highest lung cancer mortality rates in the nation; however, the recent recommendation for lung cancer screening (LCS) by the U.S. Preventive Services Task Force provides new opportunity to mitigate these rates. This study aimed to assess knowledge and attitudes regarding LCS among individuals at high risk for lung cancer.

Methods: Community health workers conducted six focus groups in rural Kentucky in fall 2014 among individuals who were eligible to receive LCS (age 55-80, smoking > 30 pack year, quit smoking <15 years ago). Focus groups sought to a.) Assess knowledge and attitudes regarding low dose CT scan (LDCT) to screen for lung cancer, b.) Identify barriers to LCS uptake, and c.) Identify meaningful communication approaches related to LCS. Qualitative analysis was conducted to identify prevailing themes.

Results: Among 56 participants in the six focus groups, no one could accurately define LCS, although many believed that pulmonary function tests, chest x-rays, or biopsies were screening tools. Once participants were informed about LCS, there was interest in obtaining this service in all focus groups.  Several wondered why their healthcare provider hadn’t already recommended it. Suggestions for message content included improved prognosis with early detection and protecting one’s health for the sake of their family. Participants suggested message appeal would be optimized with testimonials, and multiple communication channels were recommended.

Discussion:  These findings informed the development of a community outreach campaign to increase LCS in the region and may inform other high risk rural-focused lung cancer screening initiatives.