Public perspectives on ethical issues in lung cancer screening policy design and implementation in Ontario, Canada

Abstract

Purpose

Public perspectives on ethical issues in cancer screening may contribute to informing policymaking. Lung cancer screening is being implemented with the aim of reducing lung cancer mortality. Inequitable lung carcinogen exposure and lung cancer disparities are key ethical challenges in screening. This research aimed to examine public perspectives about ethical issues in lung cancer screening.

Methods

A qualitative description study was conducted in Ontario, Canada, where a provincial lung cancer screening program is being implemented. Using maximum variation sampling, Ontario residents aged 55–85 years were recruited via family medicine clinics, social media, and personal networks. Semi-structured interviews were conducted with individual participants to elicit their perspectives on established ethical issues in cancer screening, with questions focused on potential lung cancer screening benefits and harms, who should be eligible, and why.

Findings

Twenty-six individuals participated in this study. Participants were aged 61−70 years and of various education levels. Sixty-five percent were women. No participants currently smoked commercial tobacco. Participants believed screening was important for reducing lung cancer mortality and saving healthcare costs. Participants stated that screening should consider and prioritize a wider range of lung cancer risk factors, such as occupational exposures and family history of lung cancer, than factors currently being used to offer screening to those at high risk. Participants gave less priority to screening for people who currently smoke.

Conclusion

Public perspectives supported screening high-risk candidates; however, support may be undermined by smoking stigma. Screening policies should more effectively mitigate stigma and ethically justify screening candidacy decisions.