Nurses, who are frequently on the front lines of communication with patients at high risk for lung cancer, can play a critical role in increasing awareness of the relatively new option to screen for this deadly condition, Lisa Carter-Harris, PhD, APRN, ANP-C, FAAN, of Memorial Sloan Kettering Cancer Center in New York, NY, said in the Victoria Mock New Investigator Presentation on Saturday, April 13, 2019, at the ONS 44th Annual Congress in Anaheim, CA.

Recommendations for lung cancer screening are relatively recent. In 2013, the U.S. Preventive Services Task Force recommended annual screening for adults aged 55–80 with a 30 pack-year smoking history who currently smoke or have quit in the past 15 years. Medicare began covering lung cancer screening in 2015. Uptake to date, however, has been low. Studies show that minorities, uninsured, people with lower incomes, and former smokers are less likely to be screened, whereas current smokers, those with a family history of lung cancer, and those with a large number of smoking pack-years are more likely to be screened. Studies also show that stigma related to smoking, mistrust of healthcare providers, fatalism that “nothing can be done” for lung cancer, and other barriers influence participation in lung cancer screening.

Carter-Harris’s National Cancer Institute–funded research pinpoints psychological and cognitive/health belief factors that are both favorable and unfavorable to lung cancer screening. For example, low scores on instruments measuring stigma, mistrust, fatalism, worry, and fear are favorable to screening, whereas high scores are unfavorable. On the other hand, high scores on instruments measuring knowledge, perceived risk, benefits, and self-efficacy, plus a low score on perceived barriers, are favorable to screening, whereas the opposite scores on those are unfavorable.

The findings extend her research team’s prior work by identifying potentially modifiable intervention targets that can be used to tailor decision support and educational materials as clinicians participate in shared decision-making conversations about lung cancer screening with their high-risk patients, Carter-Harris said. Educating patients about screening is not a one-size-fits-all approach; tailored interventions are most effective.

The patient population targeted for lung cancer screening is unique and differs from the populations targeted for other types of cancer screening because it is targeted for a frequently stigmatized behavior (i.e., smoking). Identifying the factors that are most important in screening behavior (both predictors and mediators) is critical to designing the most effective and meaningful decision support tools. 

Because of the stigma associated with smoking, Carter-Harris said, future interventions in the population targeted for lung cancer screening should support both patients and providers in discussions about screening and should be conceptually grounded to support the inclusion of varied intervention components and to increase understanding of the factors that drive behavior change.  

Ultimately, a more robust understanding of the factors influencing lung cancer screening behavior has potentially positive implications not only for patients who are eligible for screening but also for tobacco treatment interventions in this high-risk population, she concluded.