Abstract A116: Evaluating medical mistrust in efforts to promote equity in lung cancer screening implementation
Authors: Richmond Jennifer , Fernandez Jessica R. , Bonnet Kemberlee R. , Pena Maria A. , Forde Allana T. , Schlundt David G. , Wilkins Consuelo H. , Aldrich Melinda C. 
Published: January 2023

Purpose: Lung cancer is the leading cause of cancer death in the U.S. Lung cancer screening significantly reduces lung cancer mortality, but national uptake is low (&lt;6%). Black and low-income Americans have higher lung cancer mortality rates and lower lung cancer screening rates than White and high-income Americans, respectively. Lower lung cancer screening uptake among Black and low-income populations may widen existing disparities in lung cancer mortality. Prior studies have found higher levels of medical mistrust among Black and low-income populations, perhaps arising from structural racism and other inequities. Indeed, medical mistrust may reduce cancer screening intentions, but little is known about how health systems can promote lung screening uptake while earning patient trust. To address this gap, this study aimed to identify diverse patient perspectives on increasing equity in lung screening uptake and addressing medical mistrust. Methods: We conducted 20 semi-structured interviews and four focus groups (about four participants per group) with a diverse sample of lung cancer screening-eligible individuals throughout the U.S. (i.e., individuals aged 50-80 years with eligible smoking histories). Interviews and focus groups investigated participant awareness of lung screening, barriers to screening, the role of medical mistrust in screening uptake, and perspectives on equitable screening implementation. We used an iterative inductive/deductive content analysis approach to identify key themes from interview and focus group transcripts. Results: Interview participants (n=20) were 60 years of age on average and had a mean smoking pack-year history of 42.5 years. Half of interview participants identified as Black (50%), slightly more than half of participants had a household income of &lt;$30,000 (55%), and most participants were female (60%). Focus group participants had similar demographics. Most participants were unaware of lung cancer screening but were eager to learn more. As a key barrier, participants discussed that their doctors had never mentioned lung screening, which confused and frustrated participants who had long-term relationships with primary care doctors. Prior negative healthcare experiences (e.g., misdiagnoses and having serious symptoms dismissed by healthcare providers) were also discussed as screening barriers as they engendered mistrust and hesitancy to seek future care. Several Black participants cited personal and vicarious experiences of racism in the healthcare system as key barriers contributing to mistrust and screening hesitancy. Lastly, participants raised several suggestions to promote equitable screening implementation, such as the need to meaningfully engage with communities to raise screening awareness and address cost issues. Conclusions: Lung cancer screening interventions may be more successful if concerted efforts are taken to understand and address medical mistrust. Future work is needed to address the reasons patients may mistrust healthcare providers and systems that deliver lung cancer screening.

Citation Format: Jennifer Richmond, Jessica R. Fernandez, Kemberlee R. Bonnet, Maria A. Pena, Allana T. Forde, David G. Schlundt, Consuelo H. Wilkins, Melinda C. Aldrich. Evaluating medical mistrust in efforts to promote equity in lung cancer screening implementation [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A116.