Self-blaming as a barrier to lung cancer screening and smoking cessation programs in Italy. A qualitative study

Lung cancer screening (LCS) combined with smoking cessation programs is a critical strategy for reducing lung cancer mortality. Understanding the perspectives of cigarette users and former ones on these interventions is essential for enhancing their acceptability and effectiveness. This study aimed to explore, in Italy, the perceptions and experiences of individuals eligible for LCS within the context of a smoking cessation program.

This multicenter qualitative study was conducted in two Italian regions as part of a larger project the Italian League against Cancer promoted. Using purposive sampling, we included (a) cigarette users and former ones who participated in an Italian trial, ITALUNG study, and (b) cigarette users who had been offered individual or group smoking cessation interventions and were theoretically eligible for screening in the following years (aged 50-70, ≥15 pack-years). Data were collected through open-ended semi-structured interviews and focus group meetings and analyzed using reflexive thematic analysis. The data analysis yielded six themes covering participants' views on the interactions between the two types of interventions (screening and smoking cessation program). Across their data, we generated the following themes: (i) depreciation and fatalism toward the risk of smoking, (ii) self-blaming and ethicality, (iii) ambivalent impact of the screening on smoking, (iv) LCS-related information and concerns, (v) teachable and motivating moments, and (vi) non-stigmatizing communication and testimony by professionals.

Our study underscores the importance of avoiding stigma and respecting the dignity of cigarette users in implementing LCS and smoking cessation programs. Clear communication and supportive interactions with healthcare providers are crucial for enhancing the acceptability and effectiveness of these interventions. Future research should focus on quantifying these findings and exploring additional factors influencing the acceptability and effectiveness of combined LCS and smoking cessation programs.