A recent study found that lung cancer screening interventions may be more successful with focused efforts on understanding and addressing medical mistrust among patients, according to findings presented during the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved (Abstract A116).
"The United States Preventive Services Task Force recommends lung cancer screening to reduce lung cancer mortality," noted study author Jennifer Richmond, PhD, MSPH, Postdoctoral Research Fellow at Vanderbilt University Medical Center. "Per their criteria, individuals are eligible for lung cancer screening if they are between the ages of 50 to 80 years, have a 20-pack year smoking history or more, and if they currently smoke or if they've smoked in the past 15 years."
Previous research has shown that lung cancer screening saves lives by reducing lung cancer-specific mortality, according to Richmond. However, only about 20 percent of eligible people in the United States have received screening.
"Prior research also suggests that medical mistrust or suspicion of health care providers and systems may reduce the likelihood that individuals receive preventive care, but little is known about the connection between medical mistrust and lung cancer screening specifically," she explained. "Therefore, our objective was to identify diverse patient perspectives on increasing equity in lung cancer screening uptake and addressing medical mistrust."
Study Details
Richmond and colleagues conducted 20 semi-structured interviews and four focus groups (about four participants per group) with a diverse sample of lung cancer screening-eligible individuals throughout the United States. Due to the ongoing COVID-19 pandemic, all interviews and focus groups were virtual. Participants were recruited using a national online panel.
"The interviews and focus groups elicited patient perspectives on the connection between lung cancer screening and medical mistrust, improving lung cancer screening uptake, and addressing screening barriers," said Richmond during her presentation. "We used an iterative inductive/deductive qualitative content analysis approach to identify themes from interview and focus group transcripts."
A total of 34 participants completed an interview or focus group. The average participant age was 59 years, and 59 percent identified as women and 47 percent identified as Black or African American. Additionally, 55 percent of the participants had an income below $30,000 and 24 percent had an education level of high school or less. About 79 percent of participants had never received lung cancer screening.
The interviews and focus groups revealed that, while most participants were unaware of lung cancer screening, they were eager to learn more, according to Richmond. "One participant explained, 'You hear about getting tested for colon cancer and other cancers, but nothing about lung cancer.'"
A key barrier discussed by participants was that their doctors had never mentioned lung screening, which confused and frustrated participants who had long-term relationships with primary care doctors, the study authors reported. "Prior negative health care experiences (e.g., misdiagnoses and having serious symptoms dismissed by health care providers) were also discussed as screening barriers, as they engendered mistrust and hesitancy to seek future care."
Additionally, several Black participants cited personal and vicarious experiences of racism in the health care system as key barriers contributing to mistrust and screening hesitancy, Richmond noted.
"One participant explained that 'there is a mistrust of doctors...and a lot of that distrust comes from racism and it trickles down,'" she said. "Another participant explained that 'the mistrust comes from...many of us [who] feel that the health system has failed us because it can be due to a death in the family that we feel that, well, the doctors could have prevented that...And, truth be told, it has. It's failed us.'"
Participants also offered several suggestions on how to promote equitable screening implementation. This included the need to meaningfully engage with communities to raise screening awareness and address cost issues, the study authors noted.
"Overall, results from this work suggest that lung cancer screening interventions may be more successful if concerted efforts are taken to understand and address medical mistrust," Richmond concluded. "Also, future work is needed to address the many valid reasons patients may mistrust health care providers and to improve the trustworthiness of systems that deliver lung cancer screening."
Catlin Nalley is a contributing writer.
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