Common Determinants of Lung Cancer Screening Uptake in Three High-Risk and Underserved Communities

Though lung cancer screening (LCS) has significant mortality benefits and has been recommended by the US Preventive Services Task Force since 2013, uptake has been low, especially in most underserved populations. The objective of this study was to harmonize qualitative data from three parallel studies focused on communities with historically high rates of tobacco use and who face lung cancer disparities-people with human immunodeficiency virus; individuals that identify as lesbian, gay, bisexual, transgender, queer or questioning, and others; and urban-dwelling American Indian or Alaska Native individuals-to understand common barriers and facilitators to LCS to inform clinical programming.

This qualitative study re-analyzed deidentified focus group transcripts from three recently conducted qualitative studies performed in partnership with these communities. Participants were all eligible, or near eligible, for LCS by US Preventive Services Task Force 2021 criteria. Transcripts were analyzed using inductive thematic analysis, with final themes mapped to the Health Equity Implementation Framework.

A total of 26 focus groups or interviews were analyzed, including a total of 109 participants (people with human immunodeficiency virus, n = 43; individuals that identify as lesbian, gay, bisexual, transgender, queer or questioning, and others, n = 21; American Indian or Alaska Native, n = 45). Fifteen themes emerged that represented common determinants of LCS behavior across the domains of the Health Equity Implementation Framework. Themes demonstrated broad interest in LCS and preventive health care but multilevel barriers to LCS engagement and completion. Participants endorsed facilitators such as community engagement, patient-provider information sharing, and patient navigation to enhance LCS uptake.

Despite several barriers to screening that contribute to low uptake, there are facilitators that could be used through multilevel interventions to support LCS in underserved high-risk populations.