Abstract 5737: Development of a new theoretical model on health literacy and informed decision-making about lung cancer screening
Authors: Platter Heather Nicole 
Published: September 2020

Abstract
Aims: Recent advances in screening technologies have reduced mortality and increased early stage detection of lung cancer, yet only 3.9% of 6.8 million eligible US adults were screened in 2015. Older adult long-term smokers experience dynamic health literacy and communication issues when faced with making an informed decision about lung cancer screening. Yet, there remains limited research on the impact of health literacy and the process of informed decision-making about lung cancer screening, which may be due to the paucity of a theoretical framework available to direct this research. To address this critical gap in the cancer prevention literature, this study developed a new theoretical model on health literacy and informed decision-making about lung cancer screening.
Methods: This grounded theory study was guided by the following research question: “How does health literacy relate to intentions and behaviors to screen for lung cancer?” Eligible participants were 55 to 80 years old, had a 30-pack year smoking history, any form of health insurance, and a healthcare provider seen in the past two years. Participants were recruited via Craigslist until saturation was reached. Participants completed an in-person audio-recorded intensive interview in a private location, then were asked to complete the Short Test of Functional Health Literacy in Adults. Data were transcribed verbatim, cleaned, and analyzed using constructivist grounded theory methods, proceeding through four stages of coding: 1) open; 2) focused; 3) axial; and 4) theoretical.
Results: Saturation was reached at 12 participants and mean interview time was 58 minutes. Participants were female (58.3%), black (83.3%), and a current smoker (75%) with a mean 41.8 pack-year history and mean age of 61.9. Most participants (91.7%) had adequate health literacy. Analysis of interviews informed the development of a new theoretical model underpinned by a core category: Making an Informed Decision about Lung Cancer Screening. The core category is supported by eight categories characterizing how health literacy relates to lung cancer screening among older adult long-term smokers, including Health Information Seeking Behaviors, Trusted Sources, Knowledge, Trusted Provider, Advocacy, Perceived Risk, Patient-Provider Communication, and Shared Decision-Making.
Conclusions: The analysis produced the “Health Literacy Theoretical Model of Informed Decision-Making about Lung Cancer Screening.” This theoretical model highlights the complexities of the decision-making process for lung cancer screening among older adult long-term smokers, which is highly influenced by health literacy, patient-provider communication, and health information seeking behaviors. This new theoretical model can be used by implementation scientists to develop theoretically informed interventions to facilitate the informed decision-making process with long-term smokers considering lung cancer screening.
Citation Format: Heather Nicole Platter. Development of a new theoretical model on health literacy and informed decision-making about lung cancer screening [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5737.