Psychosocial impacts of, and barriers to, lung cancer screening: An international qualitative study of multidisciplinary health professionals’ perspectives

Abstract

Objectives

Many lung cancer screening (LCS) programs are in development following landmark trials demonstrating the effectiveness of screening for reducing lung cancer mortality. Psychosocial aspects are important considerations for LCS services, both for harms to participants and as barriers to appropriate uptake. This study investigated the psychosocial impacts and determinants of LCS for screening participants from the perspective of an international, multidisciplinary sample of healthcare professionals.

Methods

Semi-structured interviews were conducted with health professionals involved in LCS delivery or design, or with LCS-eligible populations (including primary care practitioners, respiratory physicians, nurses, trial assistants/coordinators, and researchers). Participants were sampled to include perspectives across different countries, trials/programs, and policy landscapes. Data was analysed thematically.

Results

Twenty-seven participants were interviewed. Most were from England (n = 11) and Australia (n = 10), with representation across seven established LCS trials/programs. Themes generated were: (a) anxiety and fear are central to screening experiences; (b) positive psychological responses to LCS are common; (c) ingrained lung cancer fatalism underpins anxiety; (d) smoking stigma is pervasive and interacts with LCS invitation; (e) influence of family and community; (f) issues specific to LCS-eligible populations; and (g) psychosocial impacts are diverse and moderated by certain factors. Themes each included psychosocial barriers to engagement (e.g., fear of cancer, nihilism, lack of social support). Key service design recommendations were developed from findings (e.g., public awareness campaigns to reduce fatalistic perceptions).

Conclusion

Psychosocial responses to LCS are diverse, complex and uniquely influenced by smoking-based eligibility criteria and lung cancer fatalism. Similarities in perspectives across an international sample of multidisciplinary healthcare professionals suggest the potential for best-practice guidelines for optimising psychosocial outcomes and determinants of LCS.

Practice implications

Findings include key recommendations to inform LCS practice and service design. Further research investigating and testing communication strategies targeting (a) stigma and fatalism, and (b) risk and ineligibility, is needed.