Although lung cancer claims more lives than any other cancer in the United States, screening is severely underutilized, with <6% of eligible patients screened nationally in 2021 versus 76% for breast cancer and 67% for colorectal cancer. This article describes an effort to identify key reasons for the underutilization of lung cancer screening in a rural population and to develop interventions to address these barriers suitable for both a large health system and local community clinics. Data were generated from 26 stakeholder interviews (clinicians, clinical staff, and eligible patients), a review of key systems (Electronic Health Record and billing records), and feedback on the feasibility of several potential interventions by health care system staff. These data informed a human-centered design approach to identify possible interventions within a complex health care system by exposing gaps in care processes and electronic health record platforms that can lead patients to be overlooked for potentially life-saving screening. Deployed interventions included communication efforts focused on (1) increasing patient awareness, (2) improving physician patient identification, and (3) supporting patient management. Preliminary outcomes are discussed.
Early Detection of Cancer , Lung Neoplasms , Humans , United States , Rural Population , Lung Neoplasms/diagnosis , Patients , Systems Analysis
The vast majority of work in construal level theory has found a robust relationship between construal level and temporal judgments for future events: Distance is associated with the abstract, and nearness is associated with the concrete. Our work looks at the past and proposes a critical moderator that reverses this relationship: knowledge. Through experiments involving real news events, we demonstrate that people with less knowledge about events felt nearer to them when recalling them in a concrete mindset versus an abstract one. However, this relationship reverses for those with greater knowledge: They feel closer to past events when recalling them in an abstract mindset versus a concrete one. We provide evidence that this reversal stems from feelings of metacognitive ease that inform temporal judgments when knowledge (which drives what information is held available and accessible in memory) and construal mindset (which drives what information is sought from memory) coincide. Our findings suggest that in memory, there are instances where the abstract seems near and the concrete seems distant.
Knowledge , Mental Recall/physiology , Time Perception/physiology , Adult , Humans , Judgment/physiology , Young Adult
The vast majority of work in construal level theory focuses prospectively on the future. Through a series of studies controlling for knowledge about an event, we look retrospectively at the past and demonstrate that construal mindsets can materially influence how a past event is reconstructed in memory. Specifically, an event recalled in a more concrete mindset feels subjectively closer than when recalled in an abstract mindset (Studies 1-3). We present evidence suggesting this is because a concrete mindset actually makes people feel as though they know more, even if they were initially exposed to the same set of information-perceived information accessibility mediates the effect of construal level on temporal distance (Study 2). The effect of construal level on memory reconstruction extends to judgments of blame, where judgments of greater temporal distance drive a greater propensity to blame parties for negative events and temporal distance mediates these judgments (Study 3). Together, these studies are the first to demonstrate that the mindset employed when recalling an event shapes its remembrance.
