Abstract A149: Lung cancer screening needs, barriers, and facilitators among patients and health care workers in rural areas with persistent poverty in the U.S. South
Authors: Richmond Jennifer , Fetters Kelsey L. , Bonnet Kemberlee , Sellers Ashley , Schlundt David G. , Friedman Debra , Shrubsole Martha , Aldrich Melinda C. 
Published: September 2024

Purpose: Lung cancer is the leading cause of cancer death in the U.S, with mortality rates higher in counties experiencing persistent poverty (i.e., counties where ≥20% of residents have lived below the federal poverty level since 1980). Most counties experiencing persistent poverty are rural and located in the U.S. south, where lung cancer screening (LCS) rates are low but cancer burden is high. Increasing LCS rates in communities experiencing persistent poverty could reduce lung cancer mortality, but little is known about LCS needs in these communities. We assessed perceived LCS needs, barriers, and facilitators in two rural communities experiencing persistent poverty. Methods: We conducted surveys, focus groups, and interviews with patients and health care workers at two federally qualified health centers in Mississippi that serve patient populations where over 90% identify as Black/African American and over 80% have incomes below 200% of the federal poverty level. Using the United States Preventive Services Task Force LCS eligibility criteria, patients were eligible if they were age ≥50 years and had ever smoked. Health care workers (e.g., nurse practitioners and nurses) were eligible if they cared for patients aged ≥50 years in the past year. Surveys, focus groups, and interviews asked questions about LCS knowledge, attitudes, barriers, and resource needs. We used descriptive statistics to summarize survey results and an iterative inductive/deductive qualitative analysis to identify focus group/interview themes. Results: Participants were 21 health care workers (11 survey respondents, 8 focus group participants, and 2 interview participants) and 62 patients (54 survey respondents and 8 focus group participants). Most health care workers were nurse practitioners (67%) and identified as Black/African American (71%). Patients averaged 62.8 years old and most identified as Black/African American (84%). Most health care worker survey respondents knew that patients become LCS eligible at age 50 years (55%), but knowledge of other eligibility criteria (e.g., smoking history requirements) was limited. Among patient survey respondents, less than half (46%) knew LCS existed, and 52% reported that getting screened would make them feel badly about smoking. Top patient-reported LCS barriers included concerns about screening convenience, time involved, and test accuracy. Patients most trusted lung cancer specialists for LCS information and largely preferred receiving information via print materials. Focus groups/interviews revealed that LCS decisions are a function of patient and health care worker characteristics (e.g., knowledge), institutional context (e.g., transportation and screening equipment availability), and the patient decision context (e.g., cost considerations and worries that community members would gossip about a cancer diagnosis). Conclusions: Novel interventions, potentially leveraging print materials and the expertise of lung specialists, are needed to increase LCS knowledge and access in areas experiencing persistent poverty.

Citation Format: Jennifer Richmond, Kelsey L. Fetters, Kemberlee Bonnet, Ashley Sellers, David G. Schlundt, Debra Friedman, Martha Shrubsole, Melinda C. Aldrich. Lung cancer screening needs, barriers, and facilitators among patients and health care workers in rural areas with persistent poverty in the U.S. South [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A149.