Abstract B046: Factors influencing patient decision-making to complete Low Dose CT screening for lung cancer
Authors: Dwyer Kathleen , Nagykaldi Zsolt , Doescher Mark , Rhoades Dorothy A. 
Published: September 2024

Abstract
As part of a randomized, controlled trial (RCT) to increase lung cancer screening (LCS) with low-dose CT scan (LDCT) within the Choctaw Nation of Oklahoma’s tribal health system, we conducted a qualitative study to explore the barriers behind patient decisions to forego screening. Thirty eligible participants who had been in the RCT for at least one year were identified as LCS completers (n=7) or non-completers (n=23). A single interviewer completed all interviews using a semi-structured interview guide, designed to explore experiences, barriers/facilitators to LCS, factors influencing screening decisions, and suggested strategies for expanding the LCS program into the community. Interviews were recorded and transcribed verbatim. Data were analyzed using conventional content analysis. Most non-completers reported having no conversations about the availability of LCS with their primary care provider (PCP) or receiving any information about the LCS program. In contrast, the completers all reported PCP-initiated discussions about the LCS program, their risk factors, and an overview of the testing process. Key themes that emerged included fears, e.g., being unsure about what the test involves, afraid of being diagnosed with lung cancer and what might follow, and afraid of dying. Some voiced concerns, e.g., feeling guilty as active smokers and being stigmatized should they be diagnosed with lung cancer. Many participants posited that there was no reason for screening without symptoms. Lack of understanding, especially about cancer care, was identified as a contributing factor. Suggested strategies to increase the reach into the community included using existing infrastructure within Choctaw Nation, such as disseminating information through the tribal newsletter, inserts in prescription refills, and notifications via the patient portal. Community education programs at local community centers, particularly around senior citizen meals, were offered as strategies to change the perception that lung cancer is a death sentence. Hosting an informational booth at the annual tribal Labor Day festival was commonly suggested. In conclusion, multiple reasons were cited for forgoing LDCT screening. In this tribal setting, findings are similar to ones documented in other settings. This suggests that interventions to overcome these challenges may build off known evidence-based interventions, such as the recommendations for cancer prevention documented by the Community Preventive Services Task Force. Addressing fears through multiple educational approaches and adapting strategies from the American Lung Association to address stigma could lead to enhanced interventions. Finally, capitalizing on tribal resources (newsletter) and tribal events to increase LCS awareness may be promising strategies to improve screening in the local tribal setting.
Citation Format: Kathleen Dwyer, Zsolt Nagykaldi, Mark Doescher, Dorothy A. Rhoades. Factors influencing patient decision-making to complete Low Dose CT screening for lung cancer [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 B046.