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Article Title

Interviews With Patients Offered Lung Cancer Screening in Primary Care: Lessons in How Screening May Influence Smoking Cessation

Publication Date

4-30-2015

Keywords

lung cancer screening, smoking cessation

Abstract

Background/Aims: We interviewed current smokers offered lung cancer screening as part of a demonstration project to explore how the availability of screening and the receipt of screening results, including both normal and abnormal findings, potentially influences patients’ beliefs about the consequences of smoking and motivations around smoking cessation.

Methods: We conducted semistructured interviews with 37 patients identified from 7 medical centers across the United States who were identified as eligible for lung cancer screening and offered screening by their primary care provider as part of the Veteran Health Administration’s (VHA) Lung Cancer Screening Clinical Demonstration Project. Data analysis was conducted concurrently with data collection using inductive and deductive content analysis.

Results: A total of 37 current smokers participated in interviews from among 186 invited screenees purposively sampled from the Demonstration Project between April and August 2014; 11% were female and 27% non-Caucasian. Four patients (11%) declined screening, and 9 of 30 (30%) patients who were screened during the study period were identified with a nodule finding < 1 cm. We identified four themes related to smoking cessation behaviors. Screening, when offered by their primary care provider, was very appealing to many patients in contrast with “badgering” by providers about smoking cessation and descriptions of futility associated with prior quit attempts. Screening was associated with reflection and personalization about harms of smoking; however, sometimes contemplation about screening reinforced misperceptions about risks of smoking or exaggerated negative effect and worry. Patients with normal findings often interpreted the result as evidence that smoking hasn’t harmed them. Multiple patients with abnormal findings described the belief that detection of nodules meant they were being helped by technology. These patients described trusting their doctors and “watching and waiting” as the way to avoid chemo and unpleasant treatment for lung cancer, believing they can put off any action, including quitting, until there is more evidence of growth.

Discussion: We identified several concerning pathways in which screening, when offered as part of routine care and described as having proven efficacy, may negatively influence cessation. Providers should be aware of these pathways and tailor discussions to ensure screening does not lower motivations around cessation.

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