Lung Cancer Screening and Stigma: Do Smoking-related Differences in Perceived Lung Cancer Stigma Emerge Prior to Diagnosis?

Background: Most lung cancer patients report experiencing stigma (i.e., devaluation based on one's lung cancer diagnosis), which is associated with adverse health outcomes. Lung cancer is stigmatized due to its robust association with smoking and the perception of the disease as self-inflicted. Purpose: Identifying sociodemographic and smoking-related correlates of perceived stigma among lung cancer screening-eligible adults (early in the cancer care trajectory) is needed to guide proactive psychosocial interventions to reduce stigma and improve health for patients newly diagnosed with lung cancer. Methods: A national sample of lung cancer screening-eligible adults (N = 515; 64.9% female) completed questionnaires on sociodemographic information, smoking-related characteristics, and perceived smoking-related lung cancer stigma. Zero-order and multivariate relationships between sociodemographic variables, smoking-related characteristics, and stigma were evaluated using Pearson's correlations, t-tests, ANOVAs, and multivariable regression. Results: The multivariable regression demonstrated that younger age (b = -0.05, p = .047) was associated significantly with higher stigma. Additionally, women (b = 0.63, p = .015), participants who reported Hispanic/Latino ethnicity (b = 1.07, p = .049), and those with a college degree or higher (all p ≤ .029) reported significantly higher stigma, compared to men, those who did not report Hispanic/Latino ethnicity, and other education categories, respectively. None of the smoking-related characteristics were associated significantly with perceived stigma (all p > .12). Conclusions: Sociodemographic variables (rather than smoking-related characteristics) significantly and uniquely differentiated lung cancer screening-eligible adults' perception of lung cancer stigma. Smoking-related differences in lung cancer stigma may emerge following rather than prior to diagnosis.

Development of a Computer-Tailored Intervention/Decision Aid To Increase Colorectal Cancer Screening in Health Systems.

Background Non-compliance with scheduled colonoscopy is common among patients, especially in underserved populations. High no-show and late cancelation rates result in wasted resources, increased costs, and missed opportunities for colorectal cancer (CRC) screening. Among the barriers to colonoscopy is a lack of knowledge about the benefits, fears, and limited time for patient counseling. Methodology We produced a digital video disc and a website program to enhance awareness about CRC screening and address patient barriers in a population with low screening adherence. Results Patients can be educated via an interactive computer-tailored intervention with both DVD and web versions. It details the benefits and need for CRC screening, different methods of screening, and addresses patient-related barriers. Conclusions Patient education is crucial to increase CRC screening among eligible individuals. Because online engagement is affected by attention, interest, and affect, content should be concise but comprehensive.

Stakeholder Research Priorities to Promote Implementation of Shared Decision-Making for Lung Cancer Screening: An American Thoracic Society and Veterans Affairs Health Services Research and Development Statement.

Rationale: Shared decision-making (SDM) for lung cancer screening (LCS) is recommended in guidelines and required by Medicare, yet it is seldom achieved in practice. The best approach for implementing SDM for LCS remains unknown, and the 2021 U.S. Preventive Services Task Force calls for implementation research to increase uptake of SDM for LCS. Objectives: To develop a stakeholder-prioritized research agenda and recommended outcomes to advance implementation of SDM for LCS. Methods: The American Thoracic Society and VA Health Services Research and Development Service convened a multistakeholder committee with expertise in SDM, LCS, patient-centered care, and implementation science. During a virtual State of the Art conference, we reviewed evidence and identified research questions to address barriers to implementing SDM for LCS, as well as outcome constructs, which were refined by writing group members. Our committee (n = 34) then ranked research questions and SDM effectiveness outcomes by perceived importance in an online survey. Results: We present our committee's consensus on three topics important to implementing SDM for LCS: 1) foundational principles for the best practice of SDM for LCS; 2) stakeholder rankings of 22 implementation research questions; and 3) recommended outcomes, including Proctor's implementation outcomes and stakeholder rankings of SDM effectiveness outcomes for hybrid implementation-effectiveness studies. Our committee ranked questions that apply innovative implementation approaches to relieve primary care providers of the sole responsibility of SDM for LCS as highest priority. We rated effectiveness constructs that capture the patient experience of SDM as most important. Conclusions: This statement offers a stakeholder-prioritized research agenda and outcomes to advance implementation of SDM for LCS.

Adaptation and validation of the Chinese version of the lung cancer screening health belief scales.

BACKGROUND: Health belief is an important factor affecting lung cancer screening in high-risk population, but the research based on Chinese cultural background is still insufficient. Therefore, we adapted the English version of the Lung Cancer Screening Health Belief Scales (LCSHB) into the Chinese version (LCSHB-C) and examined its psychometric characteristics. METHODS: After obtaining authorization from the original author, the LCSHB-C was adapted based upon Brislin's translation model. Using a variety of community-based recruitment methods, a total of 353 participants were recruited in Fuzhou, Fujian province, China to complete the questionnaires. We combined the classical test theory and item response theory to examine the psychometric properties of the LCSHB-C. RESULTS: The Cronbach's alpha for the four subscales ranged from 0.83 ~ 0.93. The content validity index for the four subscales was ranged from 0.87 ~ 1.0. Confirmatory factor analysis supported each subscale structure model fit well. Rasch analysis results further validated the reliability and validity of the four subscales. The person reliability and separation index of each subscale ranged from 0.77 to 0.87 and 1.83 to 2.63, respectively. CONCLUSIONS: The LCSHB-C is a reliable and valid instrument used to measure health beliefs related to lung cancer screening among those high-risk for lung cancer in China, which facilitates the development of lung cancer screening programs and promotes the "three early prevention strategies" of lung cancer (i.e.,early detection, early diagnosis and early treatment).

Assessment of Lung Cancer Screening Eligibility on NCI-Designated Cancer Center Websites.

Online lung cancer screening assessments empower patients to learn about their risk for lung cancer and eligibility for screening. However, it is unknown whether these online assessments provide tailored recommendations that are consistent with national guidelines and include information to prepare patients for shared decision-making (SDM) consultations with their healthcare provider. In November 2019, we reviewed 71 NCI-Designated Cancer Center websites to identify US Preventive Services Task Force (USPSTF) guidelines for lung cancer screening eligibility and evidence-based features of shared decision-making (SDM). Only 11% of the websites included an online lung cancer screening assessment. Most assessments included tailored recommendations for screening eligibility based on USPSTF guidelines. Assessments designed to support SDM included both potential benefits and harms of undergoing lung cancer screening. Nearly all assessments directed adults to discuss the results with their healthcare provider and reinforced the importance of living a tobacco-free lifestyle. Online lung cancer screening assessments have the potential to put patients in control of knowledge about their lung cancer risk and screening eligibility. While nearly all assessments recommend patients to speak with their healthcare provider about their risk for lung cancer, patients may require more support to initiate and navigate SDM conversations with their providers.

Nicotine and cannabis vaping among adolescents in treatment for substance use disorders.

This study examined nicotine and cannabis vaping among adolescents in treatment for substance use disorders. Participants were 363 adolescents aged 12-17 (66% male, mean age = 15.5 [SD = 1.3], 46% non-Hispanic white) seen for a specialty addiction intake evaluation between 2017 and 2019 at one of six medical offices of a large, integrated health care system in Northern California. Multivariable logistic regression models tested for associations of sociodemographics, cigarette smoking, and substance use disorders with vaping behaviors. A majority of adolescents reported ever (68%) or current vaping (60%) of nicotine and/or cannabis; current vaping was similar for nicotine (50%) and cannabis (51%); 40% reported current vaping of both. Current smokers (6% of the sample) had higher odds of ever vaping (aOR = 3.95, 95%CI: 1.04-14.95). Black (versus non-Hispanic white) adolescents had lower odds of current nicotine vaping (aOR = 0.08, 95%CI: 0.02-0.37) and current vaping of both nicotine and cannabis (aOR = 0.12, 95%CI: 0.03-0.60). Having an alcohol use disorder was associated with current vaping (aOR = 2.14, 95%CI: 1.06-4.33). Those who endorsed that most friends get drunk/high (aOR = 1.87, 95%CI: 1.02-3.42) or that cannabis was their substance of choice (aOR = 2.36, 95%CI: 1.16-4.81) had higher odds of current cannabis vaping. Higher neighborhood household income ($80,000-$120,000 and >$120,000 vs. <$80,000, aORs = 2.05-9.48), never versus ever blunt use (aORs = 2.47-8.68), and intakes in 2018 and 2019 versus 2017 (aORs = 2.18-5.38) were associated with higher odds of all vaping outcomes. Vaping was common among adolescents in addiction treatment and varied with sociodemographics and substance-related factors. Research should assess how vaping impacts the development of substance use disorders and whether it interferes with addiction treatment.

Association Between Social Media Use and Vaping Among Florida Adolescents, 2019.

INTRODUCTION: With the growing popularity of vaping, evidence has emerged about the association between social media use and vaping among adolescents, possibly because of the proliferation of e-cigarette advertisements and other related content on social media. Our study examined the association between social media use and vaping among adolescents. METHODS: Using data from the 2019 Florida Youth Tobacco Survey (N = 10,776), we conducted logistic regression models on adolescent vaping status (experimental and current vaping) by nondaily and daily use of social media platforms - Facebook, Instagram, Twitter and Snapchat, controlling for other confounders. RESULTS: Use of all 4 selected social media platforms was significantly associated with vaping status (P <.001 for all). Once jointly analyzed, daily use of Instagram was significantly associated with increased relative risks of experimental (adjusted relative risk ratio [aRRR] = 1.76; 95% CI, 1.38-2.25) and current vaping (aRRR = 1.51; 95% CI, 1.16-1.95); nondaily use of Snapchat was significantly associated with increased relative risk of experimental (aRRR = 1.57; 95% CI, 1.17-2.10) and current vaping (aRRR = 1.87; 95% CI, 1.31-2.66); daily use of Snapchat was associated with increased relative risk of experimental (aRRR = 2.38; 95% CI, 1.85-3.08) and current vaping (aRRR = 5.09; 95% CI, 3.78-6.86); nondaily use of Facebook was associated with increased relative risk of current vaping (aRRR = 1.20; 95% CI, 1.00-1.43), and nondaily use of Twitter was associated with increased relative risk of current vaping (aRRR = 1.29; 95% CI, 1.07-1.56). CONCLUSION: Multilevel efforts are warranted to monitor social media use and vaping status among adolescents, including media use monitoring plans, developing counter-marketing campaigns, and strict regulatory action on social media.

Impact of smoke-free ordinance strength on smoking prevalence and lung cancer incidence.

BACKGROUND: Smoke-free ordinances (SFO) have been shown to be effective public health interventions, but there is limited data on the impact SFO on lung cancer outcomes. We explored the effect of county-level SFO strength with smoking prevalence and lung cancer incidence in Indiana. METHODS: We obtained county-level lung cancer incidence from the Indiana State Cancer Registry and county-level characteristics from the Indiana Tobacco Prevention and Cessation Commission's policy database between 1995 and 2016. Using generalized estimating equations, we performed multivariable analyses of smoking prevalence and age-adjusted lung cancer rates with respect to the strength of smoke-free ordinances at the county level over time. RESULTS: Of Indiana's 92 counties, 24 had a SFO by 2011. In 2012, Indiana enacted a state-wide SFO enforcing at least moderate level SFO protection. Mean age-adjusted lung cancer incidence per year was 76.8 per 100,000 population and mean smoking prevalence per year was 25% during the study period. Counties with comprehensive or moderate SFO had a smoking prevalence 1.2% (95% CI [-1.88, -0.52]) lower compared with counties with weak or no SFO. Counties that had comprehensive or moderate SFO also had an 8.4 (95% CI [-11.5, -5.3]) decrease in new lung cancer diagnosis per 100,000 population per year compared with counties that had weak or no SFO. CONCLUSION: Counties with stronger smoke-free air ordinances were associated with decreased smoking prevalence and fewer new lung cancer cases per year. Strengthening SFO is paramount to decreasing lung cancer incidence.

Training oncology care providers in the assessment and treatment of tobacco use and dependence.

BACKGROUND: Clinical practice guidelines for promoting smoking cessation in cancer care exist; however, most oncology settings have not established tobacco use assessment and treatment as standard care. Inadequate staff training and other implementation challenges have been identified as barriers for delivery of evidence-based tobacco treatment. Providing training in tobacco treatment tailored to the unique needs of tobacco-dependent patients with cancer is one strategy to improve adoption of best practices to promote smoking cessation in cancer care. METHODS: A tobacco treatment training program for oncology care providers (tobacco treatment training-oncology [TTT-O]) consisting of a 2-day didactic and experiential workshop followed by 6 monthly, collaboratory videoconference calls supporting participants in their efforts to implement National Comprehensive Cancer Network guidelines in their oncology settings was developed and implemented. This article presents preliminary results on program evaluation, changes in participants' self-efficacy, and progress in implementing tobacco treatment. RESULTS: Data have been obtained from the first 5 cohorts of TTT-O participants (n = 110) who completed training, course evaluations, baseline and follow-up surveys. Participants rated the training as highly favorable and reported significant gains in self-efficacy in their ability to assess and treat tobacco dependence. Participants also demonstrated significant improvements in tobacco treatment skills and implementation of several indicators of improved adoption of best practices for tobacco treatment in their cancer care settings. CONCLUSIONS: Implementation of tobacco treatment training for cancer care providers is feasible, acceptable, and can have a significant positive impact on participants' tobacco treatment skills, self-efficacy, and greater adoption of tobacco treatment delivery in cancer care.

Partnering to Increase Colorectal Cancer Screening: Perspectives of Community Advisory Board Members.

The Patient-Centered Outcomes Research Institute (PCORI) defines engagement in research as the meaningful involvement of patients, caregivers, clinicians, insurers, and others throughout the entire research process-from planning to conducting the study to disseminating study results. The purposes of this paper are to (a) describe methods used to engage community members across the various phases of a PCORI-funded comparative effectiveness trial to increase colorectal cancer screening; and (b) report results of qualitative and quantitative evaluations of community advisory board members' experiences on this project. Decisions to join and stay engaged with the study included feeling valued and appreciated, being compensated, the opportunity to contribute to research based on their skills and expertise, and being committed to colon cancer prevention efforts. Challenges identified by advisory board members included the significant time commitment, transportation, and meeting location. Lessons learned and guidance for researchers committed to patient and community engagement are described.

A 10-Year Cross-Sectional Analysis of Public, Oncologist, and Patient Attitudes About Lung Cancer and Associated Stigma.

INTRODUCTION: Lung cancer stigma negatively impacts the clinical care and outcomes of those diagnosed, resulting in enduring disparities. The objective of this study was to determine whether attitudes toward lung cancer and the stigmatization of people diagnosed have changed over a decade. METHODS: A cross-sectional survey was administered to the general public, oncologists, and people with lung cancer 10 years apart (2008 and 2018) using the same instrument and methodology. The measures of stigma agreement ratings on a five-point Likert scale were compared between 2008 and 2018 for all three sample groups. RESULTS: In 2018, a total of 1001 members of the general public, 205 oncologists, and 208 people with lung cancer were enrolled. Improvements were noted over the decade, including the availability of more treatment options. Greater disease awareness was also found, with 94% of the public reporting knowledge of lung cancer (versus 82.5% in 2008, p < 0.0001). However, no change was found in the percentage of the public reporting that patients with lung cancer are at least partially to blame for their illness (60.3% in 2018). In 2018, more people with lung cancer agreed there is a stigma associated with lung cancer (72.1 versus 54.5%, p < 0.001) and that those diagnosed are viewed or treated differently by society in general (69.4% versus 50.8%, p < 0.001). CONCLUSIONS: The results reflect recognition of treatment gains and increased visibility of lung cancer but also highlight that stigma remains a significant problem. Of critical importance to the care of those diagnosed was the unexpected increase in stigma reported by the patient population.

Rapid Scaling Up of Telehealth Treatment for Tobacco-Dependent Cancer Patients During the COVID-19 Outbreak in New York City.

Background: The (COVID-19) pandemic resulted in sudden disruption of routine clinical care necessitating rapid transformation to maintain clinical care while safely reducing virus contagion. Introduction: Memorial Sloan Kettering (MSK) experienced a rapid evolution from delivery of in-person cessation counseling services to virtual telehealth treatments for our tobacco-dependent cancer patients. Aim: To examine the effect of rapid scaling of tobacco treatment telehealth on patient engagement, as measured by attendance rates for in-person counseling visits versus remote telehealth counseling visits. We also describe the patient, clinician, and health care system challenges encountered in rapid expansion of individual and group tobacco telehealth services. Methods: Data collected from the electronic medical record during the first 4 months of the COVID-19 pandemic were examined for tobacco treatment counseling. Results: From January 1, 2020 to March 30, 2020, markedly improved patient engagement was observed in ambulatory tobacco treatment services with greater attendance at scheduled telehealth visits than in-person visits, 75% versus 60.3%, odds ratio 1.84 (confidence interval: 1.26-2.71; p < 0.001). In addition, bedside hospital counseling visits were transformed into inpatient telephone visits with high levels of sustained patient engagement. Lastly, group telehealth services were launched rapidly to increase capacity and provide greater psychosocial support for cancer patients struggling with tobacco dependence. Discussion: Clinical, Information Technology (IT), and hospital system barriers were successfully addressed for most cancer patients seeking individual telehealth treatment. Group telehealth services were found to be feasible and acceptable. Conclusions: MSK's rapid leap into virtual care delivery mitigated disruption of tobacco treatment services and demonstrated strong feasibility and acceptance for managing complex tobacco-dependent patients.

Computer-Tailored Decision Support Tool for Lung Cancer Screening: Community-Based Pilot Randomized Controlled Trial.

BACKGROUND: Lung cancer screening is a US Preventive Services Task Force Grade B recommendation that has been shown to decrease lung cancer-related mortality by approximately 20%. However, making the decision to screen, or not, for lung cancer is a complex decision because there are potential risks (eg, false positive results, overdiagnosis). Shared decision making was incorporated into the lung cancer screening guideline and, for the first time, is a requirement for reimbursement of a cancer screening test from Medicare. Awareness of lung cancer screening remains low in both the general and screening-eligible populations. When a screening-eligible person visits their clinician never having heard about lung cancer screening, engaging in shared decision making to arrive at an informed decision can be a challenge. Methods to effectively prepare patients for these clinical encounters and support both patients and clinicians to engage in these important discussions are needed. OBJECTIVE: The aim of the study was to estimate the effects of a computer-tailored decision support tool that meets the certification criteria of the International Patient Decision Aid Standards that will prepare individuals and support shared decision making in lung cancer screening decisions. METHODS: A pilot randomized controlled trial with a community-based sample of 60 screening-eligible participants who have never been screened for lung cancer was conducted. Approximately half of the participants (n=31) were randomized to view LungTalk-a web-based tailored computer program-while the other half (n=29) viewed generic information about lung cancer screening from the American Cancer Society. The outcomes that were compared included lung cancer and screening knowledge, lung cancer screening health beliefs (perceived risk, perceived benefits, perceived barriers, and self-efficacy), and perception of being prepared to engage in a discussion about lung cancer screening with their clinician. RESULTS: Knowledge scores increased significantly for both groups with greater improvement noted in the group receiving LungTalk (2.33 vs 1.14 mean change). Perceived self-efficacy and perceived benefits improved in the theoretically expected directions. CONCLUSIONS: LungTalk goes beyond other decision tools by addressing lung health broadly, in the context of performing a low-dose computed tomography of the chest that has the potential to uncover other conditions of concern beyond lung cancer, to more comprehensively educate the individual, and extends the work of nontailored decision aids in the field by introducing tailoring algorithms and message framing based upon smoking status in order to determine what components of the intervention drive behavior change when an individual is informed and makes the decision whether to be screened or not to be screened for lung cancer. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/resprot.8694.

Smoking-Related Social Interactions as Experienced by Persons Who Smoked Long-term.

PURPOSE/AIMS: Smoking-related stigma is manifested in the everyday social interactions of persons who smoke and can result in low self-esteem, diminished self-efficacy, and resistance to smoking cessation. The purpose of this study was to describe smoking-related social interactions as experienced by persons with a history of long-term smoking. DESIGN: This study used a qualitative descriptive approach. METHODS: This study is part of a larger study designed to identify factors that influence lung cancer screening participation. Data were drawn from 39 qualitative interviews with persons from the parent study. All descriptions about smoking-related social interactions found in the narratives were extracted, coded, categorized, and summarized with content analytic techniques. RESULTS: Seven different types of social interactions were identified: (a) being looked down on for smoking, (b) being humiliated for smoking in public, (c) being banished while smoking, (d) being blamed for one's health problems, (e) not "really" being blamed for smoking, (f) being told "just quit," and (g) being worried about hurting others. CONCLUSIONS: Clinical nurse specialists should promote antismoking campaigns that are not stigmatizing, discuss health risks of smoking in a respectful manner, provide evidence-based cessation resources, improve communication with persons who smoke, and address stigma in programs to improve screening for smoking-related illnesses.

Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement.

Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure.Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination.Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS.Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS.Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.

Smoking Status and Symptoms of Depression During and After Pregnancy Among Low-Income Women.

OBJECTIVE: To describe the point prevalence rates, relapse rates, smoking status, and symptoms of depression and to examine the relationship between smoking status and symptoms of depression from early pregnancy to 12 months after childbirth among low-income women. DESIGN: Secondary data analysis. SETTING: Data from the national Nurse-Family Partnership program. PARTICIPANTS: Women who were enrolled in the national Nurse-Family Partnership program between 2011 and 2016 with histories of smoking 3 months before pregnancy (N = 1,554). METHODS: We used smoking status and Edinburgh Postnatal Depression Scale scores in early pregnancy, late pregnancy, and 12 months after childbirth to identify point prevalence rates, relapse rates, smoking status, and symptoms of depression. We used chi-square and additional analyses to examine the relationship between smoking status and symptoms of depression. RESULTS: The prevalence of smoking was 30.12% (n = 468) in early pregnancy, 24.39% (n = 379) in late pregnancy, and 50.58% (n = 786) 12 months after childbirth. Prevalence rates of a positive depression screening result were 30.31% (n = 471), 20.46% (n = 318), and 18.08% (n = 281), respectively. Smoking relapse rates were 2.45% (n = 38) during the third trimester and 27.86% (n = 433) at 12 months after childbirth. Eight distinct patterns of smoking and depression were identified. Women who smoked were significantly more likely to also have positive depression screening results during the third trimester and at 12 months after childbirth compared with nonsmoking women (OR = 1.37, 95% confidence interval [1.04, 1.81] and OR = 1.93, 95% confidence interval [1.47, 2.51], respectively). CONCLUSION: Prevalence rates of smoking, relapse, and positive depression screening results were great in this sample of low-income women during and after pregnancy. Pivotal time points exist where the trajectory of smoking and depression screening patterns may change. It is important for smoking cessation interventions to incorporate mental health assessment and treatment.

Integration Through Connecting in Explanatory Sequential Mixed Method Studies.

The purposes of this methods article are to (a) discuss how integration can occur through a connecting approach in explanatory sequential mixed methods studies, (b) describe a connecting strategy developed for a study testing a conceptual model to predict lung cancer screening, and (c) describe three analytic products developed by subsequent integration procedures enabled by the connecting strategy. Connecting occurs when numeric data from a quantitative strand of a study are used to select a sample to be interviewed for a subsequent qualitative strand. Because researchers often do not fully exploit numeric data for this purpose, we developed a multi-step systematic sampling strategy that produced an interview sample of eight subgroups of five persons (n = 40) whose profiles converged with or diverged from the conceptual model in specified ways. The subgroups facilitated the development of tailored interview guides, in-depth narrative summaries, and exemplar case studies to expand the quantitative findings.

Understanding lung cancer screening behaviour using path analysis.

OBJECTIVE: Understanding lung cancer screening behaviour is crucial to identifying potentially modifiable factors for future intervention. Qualititative work has explored attitudes and beliefs about lung cancer screening from the perspective of the participant, but the theoretically grounded factors that influence screening-eligible individuals to screen are unknown. We tested an explanatory framework for lung cancer screening participation from the individual's perspective. METHODS: Data were collected as part of a sequential explanatory mixed methods study, the quantitative component of which is reported here. A national purposive sample of 515 screening-eligible participants in the United States was recruited using Facebook-targeted advertisement. Participants completed surveys assessing constructs of the Conceptual Model for Lung Cancer Screening Participation. Path analysis was used to assess the relationships between variables. RESULTS: Path analyses revealed that a clinician recommendation to screen, higher self-efficacy scores, and lower mistrust scores were directly associated with screening participation (p < 0.05). However, the link between screening behaviour and self-efficacy appeared to be fully mediated by fatalism, lung cancer fear, lung cancer family history, knowledge of lung cancer risk and screening, income, clinician recommendation, and social influence (p < 0.05). CONCLUSIONS: This study found that medical mistrust, self-efficacy, and clinician recommendation were significant in the decision of whether to screen for lung cancer. These findings offer insight into potentially modifiable targets most appropriate on which to intervene. This understanding is critical to design meaningful clinician- and patient-focused interventions.