scholarly journals Perspectives of family physicians towards access to lung cancer screening for individuals living with low income – a qualitative study

2020 ◽  
Author(s):  
Ambreen Sayani ◽  
Mandana Vahabi ◽  
Mary Ann O’Brien ◽  
Geoffrey Liu ◽  
Stephen W. Hwang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Cancer Screening ◽  
Cancer Risk ◽  
Low Income ◽  
Lung Cancer Risk ◽  
Family Physicians ◽  
Lung Cancer Screening ◽  
Preventative Care ◽  
Systems Model

Abstract Background: Individuals living with low income are less likely to participate in lung cancer screening (LCS) with low-dose computed tomography. Family physicians (FPs) are typically responsible for referring eligible patients to LCS; therefore, we sought to understand their perspectives on access to lung cancer screening for individuals living with low income in order to improve equity in access to LCS. Methods: A theory-informed thematic analysis was conducted using data collected from 11 semi-structured interviews with FPs recruited from three primary care sites in downtown Toronto. Data was coded using the Systems Model of Clinical Preventative Care as a framework and interpretation was guided by the synergies of oppression analytical lens. Results: Four overarching themes describe FP perspectives on access to LCS for individuals living with low income: the degree of social disadvantage that influences lung cancer risk and opportunities to access care; the clinical encounter, where there is often a mismatch between the complex health needs of low income individuals and structure of health care appointments; the need for equity-oriented health care, illustrated by the neglect of structural origins of health risk and the benefits of a trauma-informed approach; and finally, the multiprong strategies that will be needed in order to improve equity in health outcomes. Conclusion: An equity-oriented and interdisciplinary team based approach to care will be needed in order to improve access to LCS, and attention must be given to the upstream determinants of lung cancer in order to reduce lung cancer risk.

scholarly journals Perspectives of family physicians towards access to lung cancer screening for individuals living with low income – a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ambreen Sayani ◽  
Mandana Vahabi ◽  
Mary Ann O’Brien ◽  
Geoffrey Liu ◽  
Stephen W. Hwang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Cancer Screening ◽  
Cancer Risk ◽  
Low Income ◽  
Lung Cancer Risk ◽  
Family Physicians ◽  
Lung Cancer Screening ◽  
Preventative Care ◽  
Systems Model

Abstract Background Individuals living with low income are less likely to participate in lung cancer screening (LCS) with low-dose computed tomography. Family physicians (FPs) are typically responsible for referring eligible patients to LCS; therefore, we sought to understand their perspectives on access to lung cancer screening for individuals living with low income in order to improve equity in access to LCS. Methods A theory-informed thematic analysis was conducted using data collected from 11 semi-structured interviews with FPs recruited from three primary care sites in downtown Toronto. Data was coded using the Systems Model of Clinical Preventative Care as a framework and interpretation was guided by the synergies of oppression analytical lens. Results Four overarching themes describe FP perspectives on access to LCS for individuals living with low income: the degree of social disadvantage that influences lung cancer risk and opportunities to access care; the clinical encounter, where there is often a mismatch between the complex health needs of low income individuals and structure of health care appointments; the need for equity-oriented health care, illustrated by the neglect of structural origins of health risk and the benefits of a trauma-informed approach; and finally, the multiprong strategies that will be needed in order to improve equity in health outcomes. Conclusion An equity-oriented and interdisciplinary team based approach to care will be needed in order to improve access to LCS, and attention must be given to the upstream determinants of lung cancer in order to reduce lung cancer risk.

scholarly journals Perspectives of family physicians towards access to lung cancer screening for individuals living with low income - a qualitative study

2021 ◽  
Author(s):  
Ambreen Sayani ◽  
Mandana Vahabi ◽  
Mary Ann O’Brien ◽  
Geoffrey Liu ◽  
Stephen W. Hwang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Cancer Screening ◽  
Cancer Risk ◽  
Low Income ◽  
Lung Cancer Risk ◽  
Family Physicians ◽  
Lung Cancer Screening ◽  
Preventative Care ◽  
Systems Model

Abstract Background: Individuals living with low income are less likely to participate in lung cancer screening (LCS) with low-dose computed tomography. Family physicians (FPs) are typically responsible for referring eligible patients to LCS; therefore, we sought to understand their perspectives on access to lung cancer screening for individuals living with low income in order to improve equity in access to LCS. Methods: A theory-informed thematic analysis was conducted using data collected from 11 semi-structured interviews with FPs recruited from three primary care sites in downtown Toronto. Data was coded using the Systems Model of Clinical Preventative Care as a framework and interpretation was guided by the synergies of oppression analytical lens. Results: Four overarching themes describe FP perspectives on access to LCS for individuals living with low income: the degree of social disadvantage that influences lung cancer risk and opportunities to access care; the clinical encounter, where there is often a mismatch between the complex health needs of low income individuals and structure of health care appointments; the need for equity-oriented health care, illustrated by the neglect of structural origins of health risk and the benefits of a trauma-informed approach; and finally, the multiprong strategies that will be needed in order to improve equity in health outcomes. Conclusion: An equity-oriented and interdisciplinary team based approach to care will be needed in order to improve access to LCS, and attention must be given to the upstream determinants of lung cancer in order to reduce lung cancer risk.

scholarly journals Perspectives of Family Physicians Towards Access to Lung Cancer Screening for Individuals Living With Low Income – A Qualitative Study

2020 ◽  
Author(s):  
Ambreen Sayani ◽  
Mandana Vahabi ◽  
Mary Ann O’Brien ◽  
Geoffrey Liu ◽  
Stephen W. Hwang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Cancer Screening ◽  
Qualitative Study ◽  
Cancer Risk ◽  
Low Income ◽  
Lung Cancer Risk ◽  
Family Physicians ◽  
Lung Cancer Screening ◽  
Systems Model

Abstract Background: Individuals living with low income are less likely to participate in lung cancer screening (LCS) with low-dose computed tomography. Family physicians (FPs) are typically responsible for referring eligible patients to LCS; therefore, we sought to understand their perspectives on access to lung cancer screening for individuals living with low income in order to improve equity in access to LCS. Methods: A theory-informed qualitative study was conducted using data collected from 11 semi-structured interviews with FPs recruited from three primary care sites in downtown Toronto. Data was coded using the Systems Model of Clinical Preventative Care as a framework and interpretation was guided by the synergies of oppression analytical lens. Results: Four overarching themes describe FP perspectives on access to LCS for individuals living with low income: the degree of social disadvantage that influences lung cancer risk and opportunities to access care; the clinical encounter, where there is often a mismatch between the complex health needs of low income individuals and structure of health care appointments; the need for equity-oriented health care, illustrated by the neglect of structural origins of health risk and the benefits of a trauma-informed approach; and finally, the multiprong strategies that will be needed in order to improve equity in health outcomes. Conclusion: An equity-oriented and interdisciplinary team based approach to care will be needed in order to improve access to LCS, and attention must be given to the upstream determinants of lung cancer in order to reduce lung cancer risk.

scholarly journals Advancing Health Equity in Cancer Care: The Lived Experiences of Poverty and Access to Lung Cancer Screening.

2020 ◽  
Author(s):  
Ambreen Sayani ◽  
Mandana Vahabi ◽  
Mary Ann O’Brien ◽  
Geoffrey Liu ◽  
Stephen Hwang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Cancer Risk ◽  
Low Income ◽  
Lived Experiences ◽  
Lung Cancer Risk ◽  
Underserved Populations ◽  
Lung Cancer Screening ◽  
Screening Methods ◽  
Structural Level

Abstract Background: Individuals living with low income are more likely to smoke, have a higher risk of lung cancer, and are less likely to participate in preventative healthcare (i.e., low-dose computed tomography (LDCT) for lung cancer screening), leading to equity concerns. To inform the delivery of an organized pilot lung cancer screening program in Ontario, we sought to contextualize the lived experiences of poverty and the choice to participate in lung cancer screening. Methods: At three Toronto academic primary-care clinics, high-risk screen-eligible patients who chose or declined LDCT screening were consented; sociodemographic data was collected. Qualitative interviews were conducted. Theoretical thematic analysis was used to organize, describe and interpret the data using the morphogenetic approach as a guiding theoretical lens.Results: Eight participants chose to undergo screening; ten did not. From interviews, we identified three themes: Pathways of disadvantage (social trajectories of events that influence lung-cancer risk and health-seeking behavior), lung-cancer risk and early detection (upstream factors that shape smoking behaviour and lung-cancer screening choices), and safe spaces of care (care that is free of bias, conflict, criticism, or potentially threatening actions, ideas or conversations). We illuminate how ‘choice’ is contextual to the availability of material resources such as income and housing, and how ‘choice’ is influenced by having access to spaces of care that are free of judgement and personal bias.Conclusion: Underserved populations will require multiprong interventions that work at the individual, system and structural level to reduce inequities in lung-cancer risk and access to healthcare services such as cancer screening.

scholarly journals What is the effect of a decision aid on knowledge, values and preferences for lung cancer screening? An online pre–post study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e045160
Author(s):  
Stephen D Clark ◽  
Daniel S Reuland ◽  
Alison T Brenner ◽  
Michael P Pignone
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Cancer Risk ◽  
Decision Aid ◽  
Lung Cancer Risk ◽  
Lung Cancer Screening ◽  
False Positives ◽  
Substantial Proportion ◽  
College Degree ◽  
Out Of Pocket Costs

ObjectiveTo examine if a decision aid improves knowledge of lung cancer screening benefits and harms and which benefits and harms are most valued.DesignPre–post study.SettingOnline.Participants219 current or former (quit within the previous 15 years) smokers ages 55–80 with at least 30 pack-years of smoking.InterventionLung cancer screening video decision aid.Main measuresScreening knowledge tested by 10 pre–post questions and value of benefits and harms (reducing chance of death from lung cancer, risk of being diagnosed, false positives, biopsies, complications of biopsies and out-of-pocket costs) assessed through rating (1–5 scale) and ranking (top three ranked).ResultsMean age was 64.7±6.1, 42.5% were male, 75.4% white, 48.4% married, 28.9% with less than a college degree and 67.6% with income <US$50 000. Knowledge improved postdecision aid (pre 2.8±1.8 vs post 5.8±2.3, diff +3.0, 95% CI 2.7 to 3.3; p<0.001). For values, reducing the chance of death from lung cancer was rated and ranked highest overall (rating 4.3±1.0; 59.4% ranked first). Among harms, avoiding complications (3.7±1.3) and out-of-pocket costs (3.7±1.2) rated highest. Thirty-four per cent ranked one of four harms highest: avoiding costs 13.2%, false positives 7.3%, biopsies 7.3%, complications 5.9%. Screening intent was balanced (1–4 scale; 1-not likely 21.0%, 4-very likely 26.9%). Those ‘not likely’ to screen had greater improvement in pre–post knowledge scores and more frequently ranked a harm first than those ‘very likely’ to screen (pre–post diff:+3.5 vs +2.6, diff +0.9; 95% CI 0.1 to 1.8; p=0.023; one of four harms ranked first: 28.4% vs 11.3%, p<0.001).ConclusionsOur decision aid increased lung cancer screening knowledge among a diverse sample of screen-eligible respondents. Although a majority valued ‘reducing the chance of death from lung cancer’ highest, a substantial proportion identified harms as most important. Knowledge improvement and ranking harms highest were associated with lower intention to screen.

Predictive Accuracy of the PanCan Lung Cancer Risk Prediction Model -External Validation based on CT from the Danish Lung Cancer Screening Trial

2015 ◽  
Vol 25 (10) ◽  
pp. 3093-3099 ◽  
Author(s):  
Mathilde M. Winkler Wille ◽  
Sarah J. van Riel ◽  
Zaigham Saghir ◽  
Asger Dirksen ◽  
Jesper Holst Pedersen ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Cancer Risk ◽  
Prediction Model ◽  
Lung Cancer Risk ◽  
Predictive Accuracy ◽  
External Validation ◽  
Lung Cancer Screening ◽  
Cancer Screening Trial ◽  
Screening Trial

scholarly journals Individual 5-Year Lung Cancer Risk Prediction Model in Korea Using a Nationwide Representative Database

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3496
Author(s):  
Yohwan Yeo ◽  
Dong Wook Shin ◽  
Kyungdo Han ◽  
Sang Hyun Park ◽  
Keun-Hye Jeon ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Cancer Risk ◽  
Prediction Model ◽  
Risk Prediction ◽  
Lung Cancer Risk ◽  
Lung Cancer Screening ◽  
Risk Prediction Model ◽  
C Statistic ◽  
The Mean

Early detection of lung cancer by screening has contributed to reduce lung cancer mortality. Identifying high risk subjects for lung cancer is necessary to maximize the benefits and minimize the harms followed by lung cancer screening. In the present study, individual lung cancer risk in Korea was presented using a risk prediction model. Participants who completed health examinations in 2009 based on the Korean National Health Insurance (KNHI) database (DB) were eligible for the present study. Risk scores were assigned based on the adjusted hazard ratio (HR), and the standardized points for each risk factor were calculated to be proportional to the b coefficients. Model discrimination was assessed using the concordance statistic (c-statistic), and calibration ability assessed by plotting the mean predicted probability against the mean observed probability of lung cancer. Among candidate predictors, age, sex, smoking intensity, body mass index (BMI), presence of chronic obstructive pulmonary disease (COPD), pulmonary tuberculosis (TB), and type 2 diabetes mellitus (DM) were finally included. Our risk prediction model showed good discrimination (c-statistic, 0.810; 95% CI: 0.801–0.819). The relationship between model-predicted and actual lung cancer development correlated well in the calibration plot. When using easily accessible and modifiable risk factors, this model can help individuals make decisions regarding lung cancer screening or lifestyle modification, including smoking cessation.

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