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Banerjee SC, Malling CD, Schofield EA, Carter-Bawa L, Bylund CL, Hamann HA, Parker PA, Shen MJ, Studts JL, Williamson TJ, Ostroff JS. Empathic communication skills training to reduce lung cancer stigma: Study protocol of a cluster randomized control trial. Contemp Clin Trials 2024; 145:107669. [PMID: 39182827 PMCID: PMC11407099 DOI: 10.1016/j.cct.2024.107669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/30/2024] [Accepted: 08/22/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Prior research demonstrates that nearly all (95 %) people with lung cancer (PwLC) report stigma, and approximately half (48 %) PwLC experience stigma during clinical encounters with oncology care providers (OCPs). When stigma is experienced in a medical context, it can have undesirable consequences including patients' delaying and underreporting of symptoms, misreporting of smoking behavior, and avoiding help-seeking such as psychosocial support and cessation counseling. Multi-level interventions are needed to prevent and mitigate lung cancer stigma. One promising intervention for reducing patient perception and experience of stigma is to train OCPs in responding empathically to patient emotions and promoting empathic communication within clinical encounters. METHODS This paper describes the study protocol for a cluster randomized trial comparing Usual Care (waitlist control group) with Empathic Communication Skills (ECS) training (intervention group). For this study, we will recruit 16 community oncology practice sites, 9-11 OCPs per site, and 6 PwLCs per OCP. RESULTS The goal of this trial is to investigate the effect of the ECS training on (a) OCP primary outcomes (communication and empathic skill uptake) and secondary outcomes (ECS training appraisal - relevance, novelty, clarity; self-efficacy, attitude towards communication with patients); and (b) patient-reported primary outcomes (lung cancer stigma), and secondary outcomes (perceived clinician empathy, satisfaction with OCP communication, psychological distress, social isolation, and appraisal of care). CONCLUSION Findings from this trial will advance understanding of the effectiveness of the ECS training intervention and inform future provider-level training interventions that may reduce lung cancer stigma and improve cancer care delivery. CLINICALTRIALS govIdentifier: NCT05456841.
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Affiliation(s)
- Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4th Floor, New York, NY 10017, USA.
| | - Charlotte D Malling
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4th Floor, New York, NY 10017, USA
| | - Elizabeth A Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4th Floor, New York, NY 10017, USA
| | - Lisa Carter-Bawa
- Cancer Prevention Precision Control Institute, Center for Discovery & Innovation @ Hackensack Meridian Health, 111 Ideation Way, Nutley, NJ 07110, USA; Community Outreach & Engagement, Georgetown Lombardi Comprehensive Cancer Center, 3800 Reservoir Rd. NW, Washington D.C. 20057, USA
| | - Carma L Bylund
- Health Outcomes & Biomedical Informatics, University of Florida Health Cancer Center, 1889 Museum Rd Ste 7000 FL7, Gainesville, FL 32611, USA
| | - Heidi A Hamann
- Department of Psychology, University of Arizona, 1503 E. University Blvd., Tucson, AZ 85721, USA
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4th Floor, New York, NY 10017, USA
| | - Megan J Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, P.O. Box 19024, Seattle, WA 98109, USA
| | - Jamie L Studts
- Cancer Prevention and Control, University of Colorado Cancer Center, 13001 East 17(th) Place, MS #F434, E5333 Fitzsimons Building, Aurora, CO 80045, USA
| | - Timothy J Williamson
- Department of Psychological Science, Loyola Marymount University, 1 LMU Drive, Suite 4700, Los Angeles, CA 90045, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4th Floor, New York, NY 10017, USA
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Tieu V, MacDowell S, Tibi S, Ventayen B, Agarwal M. Identifying Populations at Risk for Lung Cancer Mortality from the National Health and Nutrition Examination Survey (2001-2018) Using the 2021 USPSTF Screening Guidelines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:781. [PMID: 38929027 PMCID: PMC11203664 DOI: 10.3390/ijerph21060781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
Lung cancer (LC) is the leading cause of cancer mortality in the United States. To combat this predicament, early screening and critically assessing its risk factors remain crucial. The aim of this study was to identify the value of specific factors from the National Health and Nutrition Examination Survey (NHANES) from 2001-2018, as they relate to lung cancer mortality in the US Preventive Services Task Force (USPSTF)-eligible population. A total of 3545 adults who met USPSTF criteria were extracted from 81,595 NHANES participants. The LC Death Risk Assessment Tool was used to calculate the number of deaths per 1000 individuals. The Mann-Whitney U test and one-way ANOVA determined the statistical significance of the factors involved in LC mortality. Male sex, African and Hispanic ethnicity, lower education attainment, and secondhand exposure to cigarette smoke correlated with an increased risk of LC mortality. Additionally, the factor of emotional support from NHANES data was analyzed and did not show any benefit to reducing risk. By identifying individuals at high-risk, preventative measures can be maximized to produce the best possible outcome.
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Richmond J, Fernandez JR, Bonnet K, Sellers A, Schlundt DG, Forde AT, Wilkins CH, Aldrich MC. Patient Lung Cancer Screening Decisions and Environmental and Psychosocial Factors. JAMA Netw Open 2024; 7:e2412880. [PMID: 38819825 PMCID: PMC11143466 DOI: 10.1001/jamanetworkopen.2024.12880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/17/2024] [Indexed: 06/01/2024] Open
Abstract
Importance Screening for lung cancer using low-dose computed tomography is associated with reduced lung cancer-specific mortality, but uptake is low in the US; understanding how patients make decisions to engage with lung cancer screening is critical for increasing uptake. Prior research has focused on individual-level psychosocial factors, but environmental factors (eg, historical contexts that include experiencing racism) and modifying factors-those that can be changed to make it easier or harder to undergo screening-also likely affect screening decisions. Objective To investigate environmental, psychosocial, and modifying factors influencing lung cancer screening decision-making and develop a conceptual framework depicting relationships between these factors. Design, Setting, and Participants This multimethod qualitative study was conducted from December 2021 to June 2022 using virtual semistructured interviews and 4 focus groups (3-4 participants per group). All participants met US Preventive Services Task Force eligibility criteria for lung cancer screening (ie, age 50-80 years, at least a 20 pack-year smoking history, and either currently smoke or quit within the past 15 years). Screening-eligible US participants were recruited using an online panel. Main Outcomes and Measures Key factors influencing screening decisions (eg, knowledge, beliefs, barriers, and facilitators) were the main outcome. A theory-informed, iterative inductive-deductive approach was applied to analyze data and develop a conceptual framework summarizing results. Results Among 34 total participants (interviews, 20 [59%]; focus groups, 14 [41%]), mean (SD) age was 59.1 (4.8) years and 20 (59%) identified as female. Half had a household income below $20 000 (17 [50%]). Participants emphasized historical and present-day racism as critical factors contributing to mistrust of health care practitioners and avoidance of medical procedures like screening. Participants reported that other factors, such as public transportation availability, also influenced decisions. Additionally, participants described psychosocial processes involved in decisions, such as perceived screening benefits, lung cancer risk appraisal, and fear of a cancer diagnosis or harmful encounters with practitioners. In addition, participants identified modifying factors (eg, insurance coverage) that could make receiving screening easier or harder. Conclusions and Relevance In this qualitative study of patient lung cancer screening decisions, environmental, psychosocial, and modifying factors influenced screening decisions. The findings suggest that systems-level interventions, such as those that help practitioners understand and discuss patients' prior negative health care experiences, are needed to promote effective screening decision-making.
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Affiliation(s)
- Jennifer Richmond
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jessica R. Fernandez
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
- NORC at the University of Chicago, Bethesda, Maryland
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
- Qualitative Research Core, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ashley Sellers
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
- Qualitative Research Core, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David G. Schlundt
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
- Qualitative Research Core, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Allana T. Forde
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Consuelo H. Wilkins
- Division of Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melinda C. Aldrich
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Carter-Bawa L, Slaven JE, Monahan PO, Brandzel S, Gao H, Wernli KJ, Lafata JE, Rawl SM. Unpacking the relationship between shared decision-making and decisional quality, decision to screen, and screening completion in lung cancer screening. PATIENT EDUCATION AND COUNSELING 2024; 122:108143. [PMID: 38237528 PMCID: PMC10922311 DOI: 10.1016/j.pec.2024.108143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/09/2023] [Accepted: 01/08/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES Lung cancer screening is a complex and individualized decision. To understand how best to support patients in this decision, we must understand how shared decision-making is associated with both decisional and behavioral outcomes. METHODS Observational cohort study combining patient survey data with electronic health record data of lung screening-eligible patients who recently engaged in a shared decision-making discussion about screening with a primary care clinician. RESULTS Using multivariable analysis (n = 529), factors associated with higher lung cancer screening decisional quality include higher knowledge (OR = 1.33, p < .0001), lower perceived benefits (OR = 0.90, p = .0004), higher perceived barriers (OR = 1.07, p < .0001), higher self-efficacy (OR = 1.13, p < .0001), and higher levels of perceiving the discussion was shared (OR = 1.04, p < .0001). Factors associated with the patient's decision to screen include older age (OR = 1.12, p = .0050) and higher self-efficacy (OR = 1.11, p = .0407). Factors associated with screening completion included older age (OR = 1.05, p = .0050), higher knowledge (OR = 1.24, p = .0045), and higher self-efficacy (OR = 1.12, p = .0003). CONCLUSIONS Shared decision-making in lung cancer screening is a dyadic process between patient and clinician. As we continue to strive for high-quality patient-centered care, patient decision quality may be enhanced by targeting key factors such as high-quality knowledge, self-efficacy, and fostering a shared discussion to support patient engagement in lung cancer screening decisions.
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Affiliation(s)
- Lisa Carter-Bawa
- Center for Discovery & Innovation at Hackensack Meridian Health, Nutley, NJ, USA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA.
| | - James E Slaven
- Indiana University School of Medicine, Department of Biostatistics and Health Data Science, Indianapolis, IN, USA
| | - Patrick O Monahan
- Indiana University School of Medicine, Department of Biostatistics and Health Data Science, Indianapolis, IN, USA
| | - Susan Brandzel
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jennifer Elston Lafata
- UNC Eshelman School of Pharmacy and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA
| | - Susan M Rawl
- Indiana University School of Nursing, Indianapolis, IN, USA; Indiana University Melvin & Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
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Lin YA, Lin X, Li Y, Wang F, Arbing R, Chen W, Huang F. Screening behaviors of high-risk individuals for lung cancer: A cross-sectional study. Asia Pac J Oncol Nurs 2024; 11:100402. [PMID: 38495639 PMCID: PMC10944110 DOI: 10.1016/j.apjon.2024.100402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/05/2024] [Indexed: 03/19/2024] Open
Abstract
Objective To investigate current screening behaviors among high-risk individuals and analyse the factors that influence them. Methods A cross-sectional of 1652 high-risk individuals were recruited in Fujian Province, China from February to October 2022. Socio-demographic characteristics of participants were collected and other survey measures included a lung cancer and lung cancer screening knowledge questionnaire and a stage of adoption algorithm. Standardized measures on surveys were comprised of the: Lung Cancer Screening Health Belief Scales, Cataldo Lung Cancer Stigma Scale, Generalized Anxiety Disorder Scale-7, Patient Health Questionnaire-9, and the Patient Trust in the Medical Profession Scale. Factors associated with screening behavior were identified using binary logistic regression analysis. Results Lung cancer screening behavior stages were largely reported as Stage 1 and Stage 2 (64.4%). The facilitators of lung cancer screening included urban residence (OR = 1.717, 95% CI: 1.224-2.408), holding administrative positions (OR = 16.601, 95% CI: 2.118-130.126), previous lung cancer screening behavior (OR = 10.331, 95% CI: 7.463-14.302), media exposure focused on lung cancer screening (OR = 1.868, 95% CI: 1.344-2.596), a high level of knowledge about lung cancer and lung cancer screening (OR = 1.256, 95% CI: 1.185-1.332), perceived risk of lung cancer (OR = 1.123, 95% CI: 1.029-1.225) and lung cancer screening health beliefs (OR = 1.090, 95% CI: 1.067-1.113). A barrier to lung cancer screening was found to be social influence (influence of friends or family) (OR = 0.669, 95% CI: 0.465-0.964). Conclusions This study found a low participation rate in lung cancer screening and identified eight factors that affected lung cancer screening behaviors among high-risk individuals. Findings suggest targeted lung cancer screening programs should be developed based on identified influencing factors in order to effectively promote awareness and uptake of lung cancer screening.
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Affiliation(s)
- Yu-An Lin
- The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, Fujian, China
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiujing Lin
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Yonglin Li
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Fangfang Wang
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Rachel Arbing
- School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Weiti Chen
- School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Feifei Huang
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
- Research Center for Nursing Humanity, Fujian Medical University, Fuzhou, Fujian, China
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Lai YK, Ye JF, Ao SH, Zhao X. Overcoming obstacles to mammography screening: Examining the role of offline healthcare barriers and online patient-provider communication. J Health Psychol 2024; 29:452-466. [PMID: 38411143 DOI: 10.1177/13591053241234260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
Barriers to accessing offline healthcare may discourage patients from undergoing mammography screening. Online patient-provider communication (OPPC) offers a supplementary health resource that can complement traditional medical encounters and facilitate mammography screening. This study examines how offline healthcare barriers influence mammography screening, taking into account OPPC as an independent variable and cancer fatalism and patient activation as two mediators. Data from the 2017, 2018, and 2020 iterations of the Health Information National Trends Survey were used for this study. Results showed that OPPC was positively linked to mammography screening. Offline healthcare barriers had a negative association with patient activation and subsequent mammography behaviors. Moreover, offline healthcare barriers and OPPC were associated with mammography screening through serial mediation of cancer fatalism and patient activation. This study has important implications for encouraging mammography screening.
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Wolf AMD, Oeffinger KC, Shih TYC, Walter LC, Church TR, Fontham ETH, Elkin EB, Etzioni RD, Guerra CE, Perkins RB, Kondo KK, Kratzer TB, Manassaram-Baptiste D, Dahut WL, Smith RA. Screening for lung cancer: 2023 guideline update from the American Cancer Society. CA Cancer J Clin 2024; 74:50-81. [PMID: 37909877 DOI: 10.3322/caac.21811] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 11/03/2023] Open
Abstract
Lung cancer is the leading cause of mortality and person-years of life lost from cancer among US men and women. Early detection has been shown to be associated with reduced lung cancer mortality. Our objective was to update the American Cancer Society (ACS) 2013 lung cancer screening (LCS) guideline for adults at high risk for lung cancer. The guideline is intended to provide guidance for screening to health care providers and their patients who are at high risk for lung cancer due to a history of smoking. The ACS Guideline Development Group (GDG) utilized a systematic review of the LCS literature commissioned for the US Preventive Services Task Force 2021 LCS recommendation update; a second systematic review of lung cancer risk associated with years since quitting smoking (YSQ); literature published since 2021; two Cancer Intervention and Surveillance Modeling Network-validated lung cancer models to assess the benefits and harms of screening; an epidemiologic and modeling analysis examining the effect of YSQ and aging on lung cancer risk; and an updated analysis of benefit-to-radiation-risk ratios from LCS and follow-up examinations. The GDG also examined disease burden data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. The GDG judged that the overall evidence was moderate and sufficient to support a strong recommendation for screening individuals who meet the eligibility criteria. LCS in men and women aged 50-80 years is associated with a reduction in lung cancer deaths across a range of study designs, and inferential evidence supports LCS for men and women older than 80 years who are in good health. The ACS recommends annual LCS with low-dose computed tomography for asymptomatic individuals aged 50-80 years who currently smoke or formerly smoked and have a ≥20 pack-year smoking history (strong recommendation, moderate quality of evidence). Before the decision is made to initiate LCS, individuals should engage in a shared decision-making discussion with a qualified health professional. For individuals who formerly smoked, the number of YSQ is not an eligibility criterion to begin or to stop screening. Individuals who currently smoke should receive counseling to quit and be connected to cessation resources. Individuals with comorbid conditions that substantially limit life expectancy should not be screened. These recommendations should be considered by health care providers and adults at high risk for lung cancer in discussions about LCS. If fully implemented, these recommendations have a high likelihood of significantly reducing death and suffering from lung cancer in the United States.
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Affiliation(s)
- Andrew M D Wolf
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Kevin C Oeffinger
- Department of Medicine, Duke University School of Medicine and Duke Cancer Institute Center for Onco-Primary Care, Durham, North Carolina, USA
| | - Tina Ya-Chen Shih
- David Geffen School of Medicine and Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California, USA
| | - Louise C Walter
- Department of Medicine, University of California San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Timothy R Church
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Elizabeth T H Fontham
- Health Sciences Center, School of Public Health, Louisiana State University, New Orleans, Louisiana, USA
| | - Elena B Elkin
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Ruth D Etzioni
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA
| | - Carmen E Guerra
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebecca B Perkins
- Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Karli K Kondo
- Early Cancer Detection Science, American Cancer Society, Atlanta, Georgia, USA
| | - Tyler B Kratzer
- Cancer Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | | | | | - Robert A Smith
- Early Cancer Detection Science, American Cancer Society, Atlanta, Georgia, USA
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Cho MK, Cho YH. Factors influencing the intention for lung cancer screening in high-risk populations for lung cancer. Asia Pac J Oncol Nurs 2024; 11:100332. [PMID: 38192279 PMCID: PMC10772583 DOI: 10.1016/j.apjon.2023.100332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/29/2023] [Indexed: 01/10/2024] Open
Abstract
Objective Utilizing low-dose computed tomography for lung cancer screening has proven effective in reducing lung cancer mortality among high-risk individuals. This study aimed to investigate the health beliefs, knowledge of lung cancer, and cancer prevention behaviors in adults at high risk for lung cancer, with the goal of identifying predictors influencing their intention to undergo lung cancer screening. Methods The study utilized a descriptive cross-sectional design. Online questionnaires, including assessments of lung cancer screening health beliefs, knowledge of lung cancer, cancer prevention behaviors, intention to undergo lung cancer screening, and participant characteristics, were distributed to 186 individuals at high risk of lung cancer through a survey link. The data collection period spanned from April 26 to May 3, 2023. Analytical procedures encompassed descriptive statistics, independent t-test, one-way ANOVA, Pearson's correlations, and hierarchical multiple regression. Results The mean score for the intention to undergo lung cancer screening in our study was 3.66 out of 5. The regression model explaining the intention to undergo lung cancer screening accounted for 34.7% of the variance. Significant factors identified included stress level (β = 0.20, P = 0.002), perceived risk (β = 0.13, P = 0.040), self-efficacy (β = 0.35, P < 0.001), and engagement in cancer prevention behavior (β = 0.26, P < 0.001). Conclusions Healthcare providers should implement psychological interventions and provide education about cancer screening for high-risk individuals, aiming to enhance their perceived risk and self-efficacy, thus promoting a higher likelihood of undergoing screening.
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Affiliation(s)
- Mi-Kyoung Cho
- Department of Nursing Science, Chungbuk National University, Cheongju, Republic of Korea
| | - Yoon Hee Cho
- Department of Nursing, College of Nursing, Dankook University, Cheonan, Republic of Korea
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Hong YR, Wheeler M, Wang R, Karanth S, Yoon HS, Meza R, Kaye F, Bian J, Jeon J, Gould MK, Braithwaite D. Patient-Provider Discussion About Lung Cancer Screening by Race and Ethnicity: Implications for Equitable Uptake of Lung Cancer Screening. Clin Lung Cancer 2024; 25:39-49. [PMID: 37673782 DOI: 10.1016/j.cllc.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Physician-patient discussions regarding lung cancer screening (LCS) are uncommon and its racial and ethnic disparities are under-investigated. We examined the racial and ethnic disparities in the trends and frequency of LCS discussion among the LCS-eligible United States (US) population. METHODS We analyzed data from the Health Information National Trends Survey from 2014 to 2020. LCS-eligible individuals were defined as adults aged 55 to 80 years old who have a current or former smoking history. We estimated the trends and frequency of LCS discussions and adjusted the probability of having an LCS discussion by racial and ethnic groups. RESULTS Among 2136 LCS-eligible participants (representing 22.7 million US adults), 12.9% (95% CI, 10.9%-15%) reported discussing LCS with their providers in the past year. The frequency of LCS discussion was lowest among non-Hispanic White participants (12.3%, 95% CI, 9.9%-14.7%) compared to other racial and ethnic groups (14.1% in Hispanic to 15.3% in non-Hispanic Black). A significant increase over time was only observed among non-Hispanic Black participants (10.1% in 2014 to 22.1% in 2020; P = .05) and non-Hispanic Whites (8.5% in 2014 to 14% in 2020; P = .02). In adjusted analyses, non-Hispanic Black participants (14.6%, 95% CI, 12.3%-16.7%) had a significantly higher probability of LCS discussion than non-Hispanic Whites (12.1%, 95% CI, 11.4%-12.7%). CONCLUSION Patient-provider LCS discussion was uncommon in the LCS-eligible US population. Non-Hispanic Black individuals were more likely to have LCS discussions than other racial and ethnic groups. There is a need for more research to clarify the discordance between LCS discussions and the actual screening uptake in this population.
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Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL; UF Health Cancer Center, Gainesville, FL.
| | - Meghann Wheeler
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL
| | - Ruixuan Wang
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL
| | - Shama Karanth
- UF Health Cancer Center, Gainesville, FL; Department of Surgery, College of Medicine, University of Florida, Gainesville, FL
| | - Hyung-Suk Yoon
- UF Health Cancer Center, Gainesville, FL; Department of Surgery, College of Medicine, University of Florida, Gainesville, FL
| | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada; Department of Epidemiology, University of Michigan, Ann Arbor, MI
| | - Frederick Kaye
- Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL
| | - Jiang Bian
- UF Health Cancer Center, Gainesville, FL; Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI
| | - Michael K Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Dejana Braithwaite
- UF Health Cancer Center, Gainesville, FL; Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL; Department of Surgery, College of Medicine, University of Florida, Gainesville, FL.
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Leopold KT, Carter-Bawa L. Barriers to Lung Cancer Screening Access from the Perspective of the Patient and Current Interventions. Thorac Surg Clin 2023; 33:343-351. [PMID: 37806737 DOI: 10.1016/j.thorsurg.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
In the context of the Conceptual Model for Lung Cancer Screening Participation, this article describes patient barriers to lung cancer screening highlighting current interventions. Patient barriers include cognitive factors (lack of awareness, limited information/misinformation, and low perceived risk), factors related to access (logistical issues, no provider recommendation, cost, and other financial/social factors), and psychological factors (fear, fatalism, lung cancer worry, and stigma). Current interventions include the use of educational materials/presentations to address cognitive barriers, use of direct outreach and structural change to address factors related to access, and use of educational material focused on psychological barriers to address psychological barriers.
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Affiliation(s)
- Katherine T Leopold
- Hackensack University School of Medicine, 123 Metro Boulevard, Nutley, NJ 07110, USA
| | - Lisa Carter-Bawa
- Cancer Prevention Precision Control Institute, Center for Discovery & Innovation, at Hackensack Meridian Health, 111 Ideation Way, B430, Nutley, NJ 07110, USA.
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Williamson TJ, Rawl SM, Kale MS, Carter-Harris L. Lung Cancer Screening and Stigma: Do Smoking-related Differences in Perceived Lung Cancer Stigma Emerge Prior to Diagnosis? STIGMA AND HEALTH 2023; 8:497-500. [PMID: 38239631 PMCID: PMC10794004 DOI: 10.1037/sah0000300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Background Most lung cancer patients report experiencing stigma (i.e., devaluation based on one's lung cancer diagnosis), which is associated with adverse health outcomes. Lung cancer is stigmatized due to its robust association with smoking and the perception of the disease as self-inflicted. Purpose Identifying sociodemographic and smoking-related correlates of perceived stigma among lung cancer screening-eligible adults (early in the cancer care trajectory) is needed to guide proactive psychosocial interventions to reduce stigma and improve health for patients newly diagnosed with lung cancer. Methods A national sample of lung cancer screening-eligible adults (N = 515; 64.9% female) completed questionnaires on sociodemographic information, smoking-related characteristics, and perceived smoking-related lung cancer stigma. Zero-order and multivariate relationships between sociodemographic variables, smoking-related characteristics, and stigma were evaluated using Pearson's correlations, t-tests, ANOVAs, and multivariable regression. Results The multivariable regression demonstrated that younger age (b = -0.05, p = .047) was associated significantly with higher stigma. Additionally, women (b = 0.63, p = .015), participants who reported Hispanic/Latino ethnicity (b = 1.07, p = .049), and those with a college degree or higher (all p ≤ .029) reported significantly higher stigma, compared to men, those who did not report Hispanic/Latino ethnicity, and other education categories, respectively. None of the smoking-related characteristics were associated significantly with perceived stigma (all p > .12). Conclusions Sociodemographic variables (rather than smoking-related characteristics) significantly and uniquely differentiated lung cancer screening-eligible adults' perception of lung cancer stigma. Smoking-related differences in lung cancer stigma may emerge following rather than prior to diagnosis.
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Affiliation(s)
- Timothy J. Williamson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Susan M. Rawl
- School of Nursing, Indiana University, Indianapolis, IN, USA
- Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Minal S. Kale
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Lisa Carter-Harris
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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12
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Carter-Bawa L, Ostroff JS, Hoover K, Studts JL. Effective Communication About Lung Cancer Screening Without Iatrogenic Stigma: A Brief Report Case Study Using the Lung Cancer Stigma Communications Assessment Tool of LungTalk. JTO Clin Res Rep 2023; 4:100585. [PMID: 38029025 PMCID: PMC10679887 DOI: 10.1016/j.jtocrr.2023.100585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Stigma thwarts progress in lung cancer risk reduction and control and adversely affects patients across the entire lung cancer care continuum. In developing and disseminating patient and public-facing interventions to increase lung screening, we must be cognizant of how communications have the potential for further stigmatization of at-risk populations. Creation of the Lung Cancer Stigma Communications Assessment Tool (LCS-CAT) version 1 was supported by the American Cancer Society's National Lung Cancer Roundtable to help content developers identify, remove, and replace potentially stigmatizing language and imagery from materials designed to engage individuals across the lung cancer continuum. Methods The LCS-CAT considers language, imagery, and context and was used to audit a public-facing health communication and decision support tool called LungTalk. Results The audit performed by two behavioral scientists revealed multiple issues in all three areas, and specific feedback and alternatives were identified. Conclusions Applying the LCS-CAT to LungTalk was a productive process that helped remove potentially stigmatizing language and imagery from this tool designed to engage individuals in the process of making an informed decision about lung screening. To support destigmatization of lung cancer, communication creators should consider a stigma biopsy on all public-facing campaigns for lung screening to help identify, eliminate, and replace messages that could compromise engagement with the lung cancer screening opportunity.
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Affiliation(s)
- Lisa Carter-Bawa
- Center for Discovery & Innovation at Hackensack Meridian Health, Cancer Prevention Precision Control Institute, Nutley, New Jersey
| | - Jamie S. Ostroff
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kaitlyn Hoover
- Cancer Prevention and Control, University of Colorado Cancer Center, Aurora, Colorado
| | - Jamie L. Studts
- Cancer Prevention and Control, University of Colorado Cancer Center, Aurora, Colorado
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13
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Zheng F, Wang K. The impact of social media on guideline-concordant cervical cancer-screening: insights from a national survey. Public Health 2023; 223:50-56. [PMID: 37598576 DOI: 10.1016/j.puhe.2023.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/12/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES Cervical cancer is one of the leading causes of cancer mortality in women, yet routine screenings lead to early detection and sometimes even prevention. Screening is an effective way to prevent cervical cancer, and it has been implemented in many countries and regions worldwide, especially in developed countries. However, the incidence of cervical cancer remains a public health problem due to screening disparities in the population. Social media engagement and overloading of online health information may be the cause of this disparity. STUDY DESIGN Cross-sectional study. METHODS Data from the Health Information National Trends Survey (a national survey conducted by the National Cancer Institute) was used to characterise cervical cancer screening into two dimensions; namely, high-frequency screening and guideline-concordant screening. The differences between these two screening frequency behaviours were compared by applying ordered logistic regression and binary logistic regression, and the mechanisms of guideline-concordant screening were explored. RESULTS The factors influencing high-frequency screening and guideline-concordant screening were different. Only self-efficacy (odds ratio [OR] = 1.16; 95% confidence interval [CI] = 0.98, 1.37) had a significant positive association with the high-frequency screening behaviour. Social media engagement (OR = 0.57; 95% CI = 0.33, 0.96) was shown to have a significant negative impact on guideline-concordant screening. A theory-based mechanism of screening behaviour found that traditional health perception factors no longer influence guideline-concordant screening behaviour, whereas environmental factors (e.g., social media) significantly reduce guideline-concordant screening behaviour. CONCLUSIONS The results from this study indicate that while the internet has become the main channel through which women acquire health resources, and social media has become a main platform for people to obtain health information, online information cannot guide people to engage in appropriate healthy behaviours. Overloading of online health information and the digital divide may lead to excessive screening. Consequently, it is important to address the screening disparity caused by health behaviours as a result of environmental factors and the digital divide.
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Affiliation(s)
- F Zheng
- School of Medicine and Health Management, Huazhong University of Science & Technology, Wuhan, Hubei, 430030, China
| | - K Wang
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Kowloon, HK SAR, China.
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14
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Golding SA, Hasson RM, Kinney LM, Kyung EJ, Bardach SH, Perry AN, Boardman MB, Halloran SR, Youkilis SL, Fay KA, Bird TL, Bridges CJ, Schifferdecker KE. Assessing and Identifying Improvements for Lung Cancer Screening in a Rural Population: A Human-Centered Design and Systems Approach. Am J Med Qual 2023; 38:218-228. [PMID: 37656607 DOI: 10.1097/jmq.0000000000000136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Although lung cancer claims more lives than any other cancer in the United States, screening is severely underutilized, with <6% of eligible patients screened nationally in 2021 versus 76% for breast cancer and 67% for colorectal cancer. This article describes an effort to identify key reasons for the underutilization of lung cancer screening in a rural population and to develop interventions to address these barriers suitable for both a large health system and local community clinics. Data were generated from 26 stakeholder interviews (clinicians, clinical staff, and eligible patients), a review of key systems (Electronic Health Record and billing records), and feedback on the feasibility of several potential interventions by health care system staff. These data informed a human-centered design approach to identify possible interventions within a complex health care system by exposing gaps in care processes and electronic health record platforms that can lead patients to be overlooked for potentially life-saving screening. Deployed interventions included communication efforts focused on (1) increasing patient awareness, (2) improving physician patient identification, and (3) supporting patient management. Preliminary outcomes are discussed.
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Affiliation(s)
- Shaun A Golding
- Center for Program Design and Evaluation, Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Rian M Hasson
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Dartmouth Health, Lebanon, NH
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Linda M Kinney
- Center for Program Design and Evaluation, Geisel School of Medicine, Dartmouth College, Hanover, NH
| | | | - Shoshana H Bardach
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Amanda N Perry
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Maureen B Boardman
- Department of Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH
- Northern New England CO-OP Practice and Community Based Research Network, Geisel School of Medicine, Hanover, NH
| | - Sean R Halloran
- Geisel School of Medicine, Dartmouth College, Hanover, NH
- Tuck School of Business, Dartmouth College, Hanover, NH
| | | | - Kayla A Fay
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Dartmouth Health, Lebanon, NH
| | | | | | - Karen E Schifferdecker
- Center for Program Design and Evaluation, Geisel School of Medicine, Dartmouth College, Hanover, NH
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH
- Department of Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH
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15
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Carter-Bawa L, Banerjee SC, Comer RS, Kale MS, King JC, Leopold KT, Monahan PO, Ostroff JS, Slaven JE, Valenzona F, Wiener RS, Rawl SM. Leveraging social media to increase lung cancer screening awareness, knowledge and uptake among high-risk populations (The INSPIRE-Lung Study): study protocol of design and methods of a community-based randomized controlled trial. BMC Public Health 2023; 23:975. [PMID: 37237339 DOI: 10.1186/s12889-023-15857-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer death for both men and women in the United States. The National Lung Screening Trial (NLST) demonstrated that low-dose computed tomography (LDCT) screening can reduce lung cancer mortality among high-risk individuals, but uptake of lung screening remains low. Social media platforms have the potential to reach a large number of people, including those who are at high risk for lung cancer but who may not be aware of or have access to lung screening. METHODS This paper discusses the protocol for a randomized controlled trial (RCT) that leverages FBTA to reach screening-eligible individuals in the community at large and intervene with a public-facing, tailored health communication intervention (LungTalk) to increase awareness of, and knowledge about, lung screening. DISCUSSION This study will provide important information to inform the ability to refine implementation processes for national population efforts to scale a public-facing health communication focused intervention using social media to increase screening uptake of appropriate, high-risk individuals. TRIAL REGISTRATION The trial is registered at clinicaltrials.gov (#NCT05824273).
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Affiliation(s)
- Lisa Carter-Bawa
- Center for Discovery & Innovation, Hackensack Meridian Health, Cancer Prevention Precision Control Institute, 111 Ideation Way, Nutley, NJ, 07110, USA.
| | | | - Robert S Comer
- Indiana University Purdue University, Indianapolis, IN, USA
| | - Minal S Kale
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | - James E Slaven
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Francis Valenzona
- Center for Discovery & Innovation, Hackensack Meridian Health, Cancer Prevention Precision Control Institute, 111 Ideation Way, Nutley, NJ, 07110, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- The Pulmonary Center, Boston University, Boston, MA, USA
| | - Susan M Rawl
- Indiana University School of Nursing, Indianapolis, IN, USA
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16
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Carter-Bawa L, Banerjee SC, Ostroff JS, Kale MS, King JC, Leopold KT, Monahan PO, Slaven JE, Wiener RS, Valenzona F, Rawl SM, Comer RS. Leveraging social media to increase lung cancer screening awareness, knowledge and uptake among high-risk populations (The INSPIRE-Lung Study): Study protocol of design and methods of a community-based randomized controlled trial. RESEARCH SQUARE 2023:rs.3.rs-2846041. [PMID: 37205569 PMCID: PMC10187372 DOI: 10.21203/rs.3.rs-2846041/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background. Lung cancer is the leading cause of cancer death for both men and women in the United States. The National Lung Screening Trial (NLST) demonstrated that low-dose computed tomography (LDCT) screening can reduce lung cancer mortality among high-risk individuals, but uptake of lung screening remains low. Social media platforms have the potential to reach a large number of people, including those who are at high risk for lung cancer but who may not be aware of or have access to lung screening. Methods. This paper discusses the protocol for a randomized controlled trial (RCT) that leverages FBTA to reach screening-eligible individuals in the community at large and intervene with a public-facing, tailored health communication intervention ( LungTalk ) to increase awareness of, and knowledge about, lung screening. Discussion. This study will provide important information to inform the ability to refine implementation processes for national population efforts to scale a public-facing health communication focused intervention using social media to increase screening uptake of appropriate, high-risk individuals. Trial Registration : The trial is registered at clinicaltrials.gov (#NCT05824273).
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17
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Williamson TJ, Walsh LE, Rawl SM, Carter-Bawa L. Slipping through the cracks: Who is eligible but does not receive a healthcare provider recommendation for lung cancer screening? Lung Cancer 2023; 179:107185. [PMID: 37023535 PMCID: PMC10219439 DOI: 10.1016/j.lungcan.2023.107185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Receiving a healthcare provider recommendation to screen is an important predictor for whether individuals at high risk for lung cancer undergo lung cancer screening. Although sociodemographic and socioeconomic characteristics are associated with differential screening participation, it is unknown whether those characteristics are associated with receiving a healthcare provider recommendation for lung cancer screening. METHODS This cross-sectional study used Facebook-targeted advertising to recruit a national sample of lung cancer screening-eligible adults (N = 515) who completed questionnaires on sociodemographic information (age, gender, race, marital status), socioeconomic characteristics (income, insurance status, education, rurality of residence), smoking status, and receiving a healthcare provider recommendation to screen. Pearson's chi-square tests and independent samples t-tests evaluated whether sociodemographic, socioeconomic, and smoking-related characteristics were associated significantly with receiving a healthcare provider recommendation to screen. RESULTS Higher household income, having insurance coverage, and being married were associated significantly with receiving a healthcare provider recommendation to screen (all p <.05). Age, gender, race, education, rurality of residence, and smoking status were not associated significantly with receiving a recommendation to screen. DISCUSSION Particular subgroups of individuals at high risk for lung cancer-including those with lower income, without insurance coverage, and who are not married-are less likely to receive a recommendation to screen from their healthcare provider, despite being at high risk for lung cancer and eligible for screening. Future research should test whether differential screening participation and low screening uptake could be addressed by clinician-focused interventions that encourage ubiquitous discussion and recommendation to undergo screening for people at high risk for lung cancer.
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Affiliation(s)
- Timothy J Williamson
- Department of Psychological Science, Loyola Marymount University, Los Angeles, CA, USA; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Leah E Walsh
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Psychology, Fordham University, Bronx, NY, USA
| | - Susan M Rawl
- School of Nursing, Indiana University, Indianapolis, IN, USA; Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Lisa Carter-Bawa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Cancer Prevention Precision Control Institute, Center for Discovery & Innovation at Hackensack Meridian Health, Nutley, NJ, USA
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18
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Carter-Bawa L, Schofield E, Atkinson TM, Ostroff JS. Development and psychometric evaluation of the Spanish version of the lung cancer screening health belief scale. Eur J Cancer Care (Engl) 2022; 31:e13707. [PMID: 36109851 PMCID: PMC10074415 DOI: 10.1111/ecc.13707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to describe the translation and psychometric testing of the Lung Cancer Screening Health Belief Scale (LCSHBS) into Spanish. METHODS The English version of the LCSHBS was professionally translated in accordance with best practices in the translation of patient-reported outcome tools. The independent certified professional translator completed a forward translation of the LCSHBS from English to Spanish, followed by a review of the translated questionnaire by a certified Memorial Sloan Kettering Cancer Center Spanish-English bicultural expert, who reviewed the scale for accuracy. RESULTS Initial testing of the scales is valid and reliable, and supports the Spanish version of the LCSHBS (LCSHBS-S). Internal consistency reliability of the scales was supported with Cronbach's ranging from 0.81 to 0.96. Construct validity was established with confirmatory factor analysis and testing for differences between individuals who have and have not screened in theoretically proposed directions. These newly translated scales can help investigators expand this research into the large Spanish-speaking lung screening-eligible population as they develop and test critical behavioural interventions to increase lung cancer screening in the at-risk population. CONCLUSIONS Development of effective interventions to enhance shared decision-making about lung cancer screening between patients and providers must first identify factors influencing the individual's screening participation. Future efforts facilitating patient-provider conversations are better informed by understanding the perspective of the individual making the decision.
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Affiliation(s)
- Lisa Carter-Bawa
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elizabeth Schofield
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Thomas M Atkinson
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jamie S Ostroff
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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19
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Silver D, Kim Y, McNeill E, Piltch-Loeb R, Wang V, Abramson D. Association between COVID-19 vaccine hesitancy and trust in the medical profession and public health officials. Prev Med 2022; 164:107311. [PMID: 36272515 PMCID: PMC9580241 DOI: 10.1016/j.ypmed.2022.107311] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 09/16/2022] [Accepted: 10/15/2022] [Indexed: 11/05/2022]
Abstract
One's personal physician, national and state or local public health officials, and the broader medical profession play important roles in encouraging vaccine uptake for COVID-19. However, the relationship between trust in these experts and vaccine hesitancy has been underexplored, particularly among racial/minority groups where historic medical mistrust may reduce uptake. Using an April 2021 online sample of US adults (n = 3041) that explored vaccine hesitancy, regression models estimate levels of trust in each of these types of experts and between trust in each of these experts and the odds of being COVID-19 vaccine takers vs refusers or hesitaters. Interaction terms assess how levels of trust in the medical profession by race/ethnicity are associated with vaccine hesitancy. Trust in each expert is positively associated with trust in other experts, except for trust in the medical profession. Only trust in one's own doctor was associated with trust in the medical profession, as measured by factor scores derived from a validated scale. Lower levels of trust in experts were significantly associated with being either a hesitater or a refuser compared to being a taker. Black respondents had higher odds of being either a hesitater or a refuser compared to white respondents but the interaction with trust was insignificant. For Hispanic respondents only, the odds of being a hesitater declined significantly when trust in the medical profession rose. Mistrust in the medical profession, one's doctor and national experts contributes to vaccine hesitancy. Mobilizing personal physicians to speak to their own patients may help.
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Affiliation(s)
- Diana Silver
- Department of Public Health Policy and Management, NYU School of Global Public Health, 708 Broadway, New York, NY 10003, USA.
| | - Yeerae Kim
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, 708 Broadway, New York, NY 10003, USA.
| | - Elizabeth McNeill
- Department of Public Health Policy and Management, NYU School of Global Public Health, 708 Broadway, New York, NY 10003, USA.
| | - Rachael Piltch-Loeb
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, 708 Broadway, New York, NY 10003, USA.
| | - Vivian Wang
- Department of Public Health Policy and Management, NYU School of Global Public Health, 708 Broadway, New York, NY 10003, USA.
| | - David Abramson
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, 708 Broadway, New York, NY 10003, USA.
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20
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Lin YA, Hong YT, Lin XJ, Lin JL, Xiao HM, Huang FF. Barriers and facilitators to uptake of lung cancer screening: A mixed methods systematic review. Lung Cancer 2022; 172:9-18. [PMID: 35963208 DOI: 10.1016/j.lungcan.2022.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/02/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022]
Abstract
Numerous factors contribute to the low adherence to lung cancer screening (LCS) programs. A theory-informed approach to identifying the obstacles and facilitators to LCS uptake is required. This study aimed to identify, assess, and synthesize the available literature at the individual and healthcare provider (HCP) levels based on a social-ecological model and identify gaps to improve practice and policy decision-making. Systematic searches were conducted in nine electronic databases from inception to December 31, 2020. We also searched Google Scholar and manually examined the reference lists of systematic reviews to include relevant articles. Primary studies were scored for quality assessment. Among 3938 potentially relevant articles, 36 studies, including 25 quantitative and 11 qualitative studies, were identified for inclusion in the review. Fifteen common factors were extracted from 34 studies, including nine barriers and six facilitators. The barriers included individual factors (n = 5), health system factors (n = 3), and social/environmental factors (n = 1). The facilitators included only individual factors (n = 6). However, two factors, age and screening harm, remain mixed. This systematic review identified and combined barriers and facilitators to LCS uptake at the individual and HCP levels. The interaction mechanisms among these factors should be further explored, which will allow the construction of tailored LCS recommendations or interventions for the Chinese context.
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Affiliation(s)
- Yu-An Lin
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Yu Ting Hong
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiu Jing Lin
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Jia Ling Lin
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Hui Min Xiao
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Fei Fei Huang
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China.
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21
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Dunlop KLA, Marshall HM, Stone E, Sharman AR, Dodd RH, Rhee JJ, McCullough S, Rankin NM. Motivation is not enough: A qualitative study of lung cancer screening uptake in Australia to inform future implementation. PLoS One 2022; 17:e0275361. [PMID: 36178960 PMCID: PMC9524683 DOI: 10.1371/journal.pone.0275361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Participation in lung cancer screening (LCS) trials and real-world programs is low, with many people at high-risk for lung cancer opting out of baseline screening after registering interest. We aimed to identify the potential drivers of participation in LCS in the Australian setting, to inform future implementation. Methods Semi-structured telephone interviews were conducted with individuals at high-risk of lung cancer who were eligible for screening and who had either participated (‘screeners’) or declined to participate (‘decliners’) in the International Lung Screening Trial from two Australian sites. Interview guide development was informed by the Precaution Adoption Process Model. Interviews were audio-recorded, transcribed and analysed using the COM-B model of behaviour to explore capability, opportunity and motivation related to screening behaviour. Results Thirty-nine participants were interviewed (25 screeners; 14 decliners). Motivation to participate in screening was high in both groups driven by the lived experience of lung cancer and a belief that screening is valuable, however decliners unlike their screening counterparts reported low self-efficacy. Decliners in our study reported challenges in capability including ability to attend and in knowledge and understanding. Decliners also reported challenges related to physical and social opportunity, in particular location as a barrier and lack of family support to attend screening. Conclusion Our findings suggest that motivation alone may not be sufficient to change behaviour related to screening participation, unless capability and opportunity are also considered. Focusing strategies on barriers related to capability and opportunity such as online/telephone support, mobile screening programs and financial assistance for screeners may better enhance screening participation. Providing funding for clinicians to support individuals in decision-making and belief in self-efficacy may foster motivation. Targeting interventions that connect eligible individuals with the LCS program will be crucial for successful implementation.
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Affiliation(s)
- Kate L. A. Dunlop
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- * E-mail:
| | - Henry M. Marshall
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
- The University of Queensland Thoracic Research Centre, Brisbane, QLD, Australia
| | - Emily Stone
- Department of Thoracic Medicine and Lung Transplantation, St Vincent’s Hospital, Darlinghurst, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Ashleigh R. Sharman
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rachael H. Dodd
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Joel J. Rhee
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | | | - Nicole M. Rankin
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia
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22
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Kim RY, Rendle KA, Mitra N, Saia CA, Neslund-Dudas C, Greenlee RT, Burnett-Hartman AN, Honda SA, Simoff MJ, Schapira MM, Croswell JM, Meza R, Ritzwoller DP, Vachani A. Racial Disparities in Adherence to Annual Lung Cancer Screening and Recommended Follow-Up Care: A Multicenter Cohort Study. Ann Am Thorac Soc 2022; 19:1561-1569. [PMID: 35167781 PMCID: PMC9447384 DOI: 10.1513/annalsats.202111-1253oc] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/14/2022] [Indexed: 11/20/2022] Open
Abstract
Rationale: Black patients receive recommended lung cancer screening (LCS) follow-up care less frequently than White patients, but it is unknown if this racial disparity persists across both decentralized and centralized LCS programs. Objectives: To determine adherence to American College of Radiology Lung Imaging Reporting and Data System (Lung-RADS) recommendations among individuals undergoing LCS at either decentralized or centralized programs and to evaluate the association of race with LCS adherence. Methods: We performed a multicenter retrospective cohort study of patients receiving LCS at five heterogeneous U.S. healthcare systems. We calculated adherence to annual LCS among patients with a negative baseline screen (Lung-RADS 1 or 2) and recommended follow-up care among those with a positive baseline screen (Lung-RADS 3, 4A, 4B, or 4X) stratified by type of LCS program and evaluated the association between race and adherence using multivariable modified Poisson regression. Results: Of the 6,134 total individuals receiving LCS, 5,142 (83.8%) had negative baseline screens, and 992 (16.2%) had positive baseline screens. Adherence to both annual LCS (34.8% vs. 76.1%; P < 0.001) and recommended follow-up care (63.9% vs. 74.6%; P < 0.001) was lower at decentralized compared with centralized programs. Among individuals with negative baseline screens, a racial disparity in adherence was observed only at decentralized screening programs (interaction term, P < 0.001). At decentralized programs, Black race was associated with 27% reduced adherence to annual LCS (adjusted relative risk [aRR], 0.73; 95% confidence interval [CI], 0.63-0.84), whereas at centralized programs, no effect by race was observed (aRR, 0.98; 95% CI, 0.91-1.05). In contrast, among those with positive baseline screens, there was no significant difference by race for adherence to recommended follow-up care by type of LCS program (decentralized aRR, 0.95; 95% CI, 0.81-1.11; centralized aRR, 0.81; 95% CI, 0.71-0.93; interaction term, P = 0.176). Conclusions: In this large multicenter study of individuals screened for lung cancer, adherence to both annual LCS and recommended follow-up care was greater at centralized screening programs. Black patients were less likely to receive annual LCS than White patients at decentralized compared with centralized LCS programs. Our results highlight the need for further study of healthcare system-level mechanisms to optimize longitudinal LCS care.
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Affiliation(s)
- Roger Y. Kim
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine
| | - Katharine A. Rendle
- Department of Family Medicine and Community Health
- Department of Biostatistics, Epidemiology, and Informatics, and
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, and
| | | | | | | | | | - Stacey A. Honda
- Center for Health Research, Kaiser Permanente Hawaii, Oahu, Hawaii
| | - Michael J. Simoff
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Marilyn M. Schapira
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer M. Croswell
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, Maryland; and
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | | | - Anil Vachani
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine
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23
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Lin YA, Carter-Harris L, Yang JN, Lin XJ, Huang FF. Adaptation and validation of the Chinese version of the lung cancer screening health belief scales. BMC Public Health 2022; 22:620. [PMID: 35354440 PMCID: PMC8969234 DOI: 10.1186/s12889-022-13041-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Health belief is an important factor affecting lung cancer screening in high-risk population, but the research based on Chinese cultural background is still insufficient. Therefore, we adapted the English version of the Lung Cancer Screening Health Belief Scales (LCSHB) into the Chinese version (LCSHB-C) and examined its psychometric characteristics. METHODS After obtaining authorization from the original author, the LCSHB-C was adapted based upon Brislin's translation model. Using a variety of community-based recruitment methods, a total of 353 participants were recruited in Fuzhou, Fujian province, China to complete the questionnaires. We combined the classical test theory and item response theory to examine the psychometric properties of the LCSHB-C. RESULTS The Cronbach's alpha for the four subscales ranged from 0.83 ~ 0.93. The content validity index for the four subscales was ranged from 0.87 ~ 1.0. Confirmatory factor analysis supported each subscale structure model fit well. Rasch analysis results further validated the reliability and validity of the four subscales. The person reliability and separation index of each subscale ranged from 0.77 to 0.87 and 1.83 to 2.63, respectively. CONCLUSIONS The LCSHB-C is a reliable and valid instrument used to measure health beliefs related to lung cancer screening among those high-risk for lung cancer in China, which facilitates the development of lung cancer screening programs and promotes the "three early prevention strategies" of lung cancer (i.e.,early detection, early diagnosis and early treatment).
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Affiliation(s)
- Yu-An Lin
- School of Nursing, Fujian Medical University, Fuzhou, China
| | | | - Jia-Ni Yang
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Xiu Jing Lin
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Fei Fei Huang
- School of Nursing, Fujian Medical University, Fuzhou, China.
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24
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Carter-Harris L. Hidden in plain sight: psychological barriers to participation in lung cancer screening. Thorax 2020; 75:1033-1034. [PMID: 33139448 DOI: 10.1136/thoraxjnl-2020-216191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Lisa Carter-Harris
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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25
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Abstract
PURPOSE/AIMS Smoking-related stigma is manifested in the everyday social interactions of persons who smoke and can result in low self-esteem, diminished self-efficacy, and resistance to smoking cessation. The purpose of this study was to describe smoking-related social interactions as experienced by persons with a history of long-term smoking. DESIGN This study used a qualitative descriptive approach. METHODS This study is part of a larger study designed to identify factors that influence lung cancer screening participation. Data were drawn from 39 qualitative interviews with persons from the parent study. All descriptions about smoking-related social interactions found in the narratives were extracted, coded, categorized, and summarized with content analytic techniques. RESULTS Seven different types of social interactions were identified: (a) being looked down on for smoking, (b) being humiliated for smoking in public, (c) being banished while smoking, (d) being blamed for one's health problems, (e) not "really" being blamed for smoking, (f) being told "just quit," and (g) being worried about hurting others. CONCLUSIONS Clinical nurse specialists should promote antismoking campaigns that are not stigmatizing, discuss health risks of smoking in a respectful manner, provide evidence-based cessation resources, improve communication with persons who smoke, and address stigma in programs to improve screening for smoking-related illnesses.
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26
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Draucker CB, Rawl SM, Vode E, Carter-Harris L. Integration Through Connecting in Explanatory Sequential Mixed Method Studies. West J Nurs Res 2020; 42:1137-1147. [PMID: 32389099 DOI: 10.1177/0193945920914647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purposes of this methods article are to (a) discuss how integration can occur through a connecting approach in explanatory sequential mixed methods studies, (b) describe a connecting strategy developed for a study testing a conceptual model to predict lung cancer screening, and (c) describe three analytic products developed by subsequent integration procedures enabled by the connecting strategy. Connecting occurs when numeric data from a quantitative strand of a study are used to select a sample to be interviewed for a subsequent qualitative strand. Because researchers often do not fully exploit numeric data for this purpose, we developed a multi-step systematic sampling strategy that produced an interview sample of eight subgroups of five persons (n = 40) whose profiles converged with or diverged from the conceptual model in specified ways. The subgroups facilitated the development of tailored interview guides, in-depth narrative summaries, and exemplar case studies to expand the quantitative findings.
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Affiliation(s)
| | - Susan M Rawl
- Indiana University School of Nursing, Indianapolis, Indiana, USA.,Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | - Emilee Vode
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Lisa Carter-Harris
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, USA
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