The impact of perceived risk, screening eligibility and worry on preference for lung cancer screening: a cross-sectional survey

Abstract

Lung cancer screening is effective at reducing lung cancer deaths when individuals at greatest risk are screened. Recruitment initiatives target all current and former smokers, of whom only some are eligible for screening, potentially leading to discordance between screening preference and eligibility in ineligible individuals. The objective of the present study was to identify factors associated with preference for screening among ever-smokers.Ever-smokers aged 55–80 years attending outpatient clinics at three Australian hospitals were invited. The survey recorded: 1) demographics; 2) objective lung cancer risk and screening eligibility using the Prostate Lung Colon Ovarian 2012 risk model; and 3) perceived lung cancer risk, worry about and seriousness of lung cancer using a validated questionnaire. Multivariable ordinal logistic regression identified predictors of screening preference.The survey was completed by 283 individuals (response rate 27%). Preference for screening was high (72%) with no significant difference between low-dose computed tomography screening-eligible and -ineligible individuals (77% versus 68%, p=0.11). Worry about lung cancer (adjusted-proportional odds ratio (adj-OR) 1.31, 95% CI 1.08–1.58; p=0.007) and perceived seriousness of lung cancer (adj-OR 1.31, 95% CI 1.05–1.64; p=0.02) were associated with higher preference for lung cancer screening while screening eligibility was not. The concept of “early detection” was the most important driver to have screening while practical obstacles like difficulty travelling to the scan or taking time off work were the least important barriers to screening.Most current or former smokers prefer to undergo screening. Worry about lung cancer and perceived seriousness of the diagnosis are more important drivers for screening preference than eligibility status.

Risk Perception Among a Lung Cancer Screening Population

“…Of note, a recent relatively small (n ¼ 283) survey-based study assessing smokers and their screening preferences found a weak correlation (Pearson r ¼ 0.28, P < .0001) between perceived lung cancer risk and risk calculated by model PLCOm2012. 34 The median risk in that study was much lower than in our study, 1.28% (interquartile range, 0.44%-3.11%), but implies that further confirmation of risk perception over the full spectrum of risk is warranted.…”

“…These findings support our hypothesis that concern for personal risk of lung cancer is likely to be a significant motivator for joining an LCS trial. 31,33,34 However, whether risk perception alone induces sufficient motivation to join an LCS study or program remains to be answered.…”

Understanding patient barriers and facilitators to uptake of lung screening using low dose computed tomography: a mixed methods scoping review of the current literature

“…Schnoll et al 2003, Lung Cancer [ 52 ] 17. See et al 2020, ERJ Open Research [ 53 ] 18. Smits et al 2018, Health Expectations [ 54 ] 19.…”

Implementation of lung cancer screening: what are the main issues?

“…Factors associated with (intended) lung cancer screening uptake are for example the smoking status, the perceived (lung cancer) risk/worry/stigma, knowledge, nicotine dependency, the perceived benefits of the detection and treatment of early stage lung cancer. Practical aspects of lung cancer screening as the distance to the screening site and referrals from clinicians turned out to be important too (20)(21)(22)(23)(24)(25).…”