Factors Associated With Obtaining Lung Cancer Screening Among Persons Who Smoke

Kristin G. Maki; Kaiping Liao; Lisa M. Lowenstein; M. Angeles Lopez-Olivo; Robert J. Volk

doi:10.1177/23814683211067810

Factors Associated With Obtaining Lung Cancer Screening Among Persons Who Smoke

Kristin G. Maki, Kaiping Liao, Lisa M. Lowenstein, M. Angeles Lopez-Olivo, Robert J. Volk

Health Services Research

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Background. Screening with low-dose computed tomography scans can reduce lung cancer deaths but uptake remains low. This study examines psychosocial factors associated with obtaining lung cancer screening (LCS) among individuals. Methods. This is a secondary analysis of a randomized clinical trial conducted with 13 state quitlines’ clients. Participants who met age and smoking history criteria were enrolled and followed-up for 6 months. Only participants randomized to the intervention group (a patient decision aid) were included in this analysis. A logistic regression was performed to identify determinants of obtaining LCS 6 months after the intervention. Results. There were 204 participants included in this study. Regarding individual attitudes, high and moderate levels of concern about overdiagnosis were associated with a decreased likelihood of obtaining LCS compared with lower levels of concern (high levels of concern, odds ratio [OR] 0.17, 95% confidence interval [CI] 0.04–0.65; moderate levels of concern, OR 0.15, 95% CI 0.05–0.53). In contrast, higher levels of anticipated regret about not obtaining LCS and later being diagnosed with lung cancer were associated with an increased likelihood of being screened compared with lower levels of anticipated regret (OR 5.59, 95% CI 1.72–18.10). Other potential harms related to LCS were not significant. Limitations. Follow-up may not have been long enough for all individuals who wished to be screened to complete the scan. Additionally, participants may have been more health motivated due to recruitment via tobacco quitlines. Conclusions. Anticipated regret about not obtaining screening is associated with screening behavior, whereas concern about overdiagnosis is associated with decreased likelihood of LCS. Implications. Decision support research may benefit from further examining anticipated regret in screening decisions. Additional training and information may be helpful to address concerns regarding overdiagnosis.

Original language	English (US)
Journal	MDM Policy and Practice
Volume	6
Issue number	2
DOIs	https://doi.org/10.1177/23814683211067810
State	Published - Dec 2021

Keywords

anticipated regret
decision-making
low-dose CT scan
lung cancer screening
overdiagnosis

ASJC Scopus subject areas

Health Policy
Public Health, Environmental and Occupational Health

MD Anderson CCSG core facilities

Shared Decision Making Core

Access to Document

10.1177/23814683211067810

Cite this

@article{e6bf77ad9d1e4b968cd3ee98934c2966,

title = "Factors Associated With Obtaining Lung Cancer Screening Among Persons Who Smoke",

abstract = "Background. Screening with low-dose computed tomography scans can reduce lung cancer deaths but uptake remains low. This study examines psychosocial factors associated with obtaining lung cancer screening (LCS) among individuals. Methods. This is a secondary analysis of a randomized clinical trial conducted with 13 state quitlines{\textquoteright} clients. Participants who met age and smoking history criteria were enrolled and followed-up for 6 months. Only participants randomized to the intervention group (a patient decision aid) were included in this analysis. A logistic regression was performed to identify determinants of obtaining LCS 6 months after the intervention. Results. There were 204 participants included in this study. Regarding individual attitudes, high and moderate levels of concern about overdiagnosis were associated with a decreased likelihood of obtaining LCS compared with lower levels of concern (high levels of concern, odds ratio [OR] 0.17, 95% confidence interval [CI] 0.04–0.65; moderate levels of concern, OR 0.15, 95% CI 0.05–0.53). In contrast, higher levels of anticipated regret about not obtaining LCS and later being diagnosed with lung cancer were associated with an increased likelihood of being screened compared with lower levels of anticipated regret (OR 5.59, 95% CI 1.72–18.10). Other potential harms related to LCS were not significant. Limitations. Follow-up may not have been long enough for all individuals who wished to be screened to complete the scan. Additionally, participants may have been more health motivated due to recruitment via tobacco quitlines. Conclusions. Anticipated regret about not obtaining screening is associated with screening behavior, whereas concern about overdiagnosis is associated with decreased likelihood of LCS. Implications. Decision support research may benefit from further examining anticipated regret in screening decisions. Additional training and information may be helpful to address concerns regarding overdiagnosis.",

keywords = "anticipated regret, decision-making, low-dose CT scan, lung cancer screening, overdiagnosis",

author = "Maki, {Kristin G.} and Kaiping Liao and Lowenstein, {Lisa M.} and Lopez-Olivo, {M. Angeles} and Volk, {Robert J.}",

note = "Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Financial support for this study was provided, in part, by a cancer prevention fellowship for Kristin Maki, supported by the Cancer Prevention and Research Institute of Texas (CPRIT) Grant Award RP170259, Shine Chang, PhD, Principal Investigator; CPRIT grants RP160674 and RP190210; and by the MD Anderson Cancer Center Support Grant, CA016672, funded by the National Cancer Institute. This study was also supported in part by award CER-1306-03385 from the Patient-Centered Outcomes Research Institute; award P30CA016672 from the National Institutes of Health, National Cancer Institute (Volk) that used the Biostatistics Resource Group, Clinical Protocol and Data Management, and Shared Decision Making Core, and a grant from The University of Texas MD Anderson Cancer Center Duncan Family Institute for Cancer Prevention and Risk Assessment (Volk) that supported the Shared Decision Making Collaborative and Center for Community-Engaged Translational Research. The funding agreement ensured the authors{\textquoteright} independence in designing the study, interpreting the data, writing, and publishing the report. Publisher Copyright: {\textcopyright} The Author(s) 2021.",

year = "2021",

month = dec,

doi = "10.1177/23814683211067810",

language = "English (US)",

volume = "6",

journal = "MDM Policy and Practice",

issn = "2381-4683",

publisher = "SAGE Publications Inc.",

number = "2",

}

TY - JOUR

T1 - Factors Associated With Obtaining Lung Cancer Screening Among Persons Who Smoke

AU - Maki, Kristin G.

AU - Liao, Kaiping

AU - Lowenstein, Lisa M.

AU - Lopez-Olivo, M. Angeles

AU - Volk, Robert J.

N1 - Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Financial support for this study was provided, in part, by a cancer prevention fellowship for Kristin Maki, supported by the Cancer Prevention and Research Institute of Texas (CPRIT) Grant Award RP170259, Shine Chang, PhD, Principal Investigator; CPRIT grants RP160674 and RP190210; and by the MD Anderson Cancer Center Support Grant, CA016672, funded by the National Cancer Institute. This study was also supported in part by award CER-1306-03385 from the Patient-Centered Outcomes Research Institute; award P30CA016672 from the National Institutes of Health, National Cancer Institute (Volk) that used the Biostatistics Resource Group, Clinical Protocol and Data Management, and Shared Decision Making Core, and a grant from The University of Texas MD Anderson Cancer Center Duncan Family Institute for Cancer Prevention and Risk Assessment (Volk) that supported the Shared Decision Making Collaborative and Center for Community-Engaged Translational Research. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. Publisher Copyright: © The Author(s) 2021.

PY - 2021/12

Y1 - 2021/12

N2 - Background. Screening with low-dose computed tomography scans can reduce lung cancer deaths but uptake remains low. This study examines psychosocial factors associated with obtaining lung cancer screening (LCS) among individuals. Methods. This is a secondary analysis of a randomized clinical trial conducted with 13 state quitlines’ clients. Participants who met age and smoking history criteria were enrolled and followed-up for 6 months. Only participants randomized to the intervention group (a patient decision aid) were included in this analysis. A logistic regression was performed to identify determinants of obtaining LCS 6 months after the intervention. Results. There were 204 participants included in this study. Regarding individual attitudes, high and moderate levels of concern about overdiagnosis were associated with a decreased likelihood of obtaining LCS compared with lower levels of concern (high levels of concern, odds ratio [OR] 0.17, 95% confidence interval [CI] 0.04–0.65; moderate levels of concern, OR 0.15, 95% CI 0.05–0.53). In contrast, higher levels of anticipated regret about not obtaining LCS and later being diagnosed with lung cancer were associated with an increased likelihood of being screened compared with lower levels of anticipated regret (OR 5.59, 95% CI 1.72–18.10). Other potential harms related to LCS were not significant. Limitations. Follow-up may not have been long enough for all individuals who wished to be screened to complete the scan. Additionally, participants may have been more health motivated due to recruitment via tobacco quitlines. Conclusions. Anticipated regret about not obtaining screening is associated with screening behavior, whereas concern about overdiagnosis is associated with decreased likelihood of LCS. Implications. Decision support research may benefit from further examining anticipated regret in screening decisions. Additional training and information may be helpful to address concerns regarding overdiagnosis.

AB - Background. Screening with low-dose computed tomography scans can reduce lung cancer deaths but uptake remains low. This study examines psychosocial factors associated with obtaining lung cancer screening (LCS) among individuals. Methods. This is a secondary analysis of a randomized clinical trial conducted with 13 state quitlines’ clients. Participants who met age and smoking history criteria were enrolled and followed-up for 6 months. Only participants randomized to the intervention group (a patient decision aid) were included in this analysis. A logistic regression was performed to identify determinants of obtaining LCS 6 months after the intervention. Results. There were 204 participants included in this study. Regarding individual attitudes, high and moderate levels of concern about overdiagnosis were associated with a decreased likelihood of obtaining LCS compared with lower levels of concern (high levels of concern, odds ratio [OR] 0.17, 95% confidence interval [CI] 0.04–0.65; moderate levels of concern, OR 0.15, 95% CI 0.05–0.53). In contrast, higher levels of anticipated regret about not obtaining LCS and later being diagnosed with lung cancer were associated with an increased likelihood of being screened compared with lower levels of anticipated regret (OR 5.59, 95% CI 1.72–18.10). Other potential harms related to LCS were not significant. Limitations. Follow-up may not have been long enough for all individuals who wished to be screened to complete the scan. Additionally, participants may have been more health motivated due to recruitment via tobacco quitlines. Conclusions. Anticipated regret about not obtaining screening is associated with screening behavior, whereas concern about overdiagnosis is associated with decreased likelihood of LCS. Implications. Decision support research may benefit from further examining anticipated regret in screening decisions. Additional training and information may be helpful to address concerns regarding overdiagnosis.

KW - anticipated regret

KW - decision-making

KW - low-dose CT scan

KW - lung cancer screening

KW - overdiagnosis

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U2 - 10.1177/23814683211067810

DO - 10.1177/23814683211067810

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C2 - 34993342

AN - SCOPUS:85121644281

SN - 2381-4683

VL - 6

JO - MDM Policy and Practice

JF - MDM Policy and Practice

IS - 2

ER -

Factors Associated With Obtaining Lung Cancer Screening Among Persons Who Smoke

Abstract

Keywords

ASJC Scopus subject areas

MD Anderson CCSG core facilities

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