"I Was Expecting the Worst": Exploring Barriers and Facilitators to Lung Cancer Screening in Black and Hispanic...

Lung cancer screening (LCS) with low-dose computed tomography reduces lung cancer mortality but remains underutilized, particularly among Black and Hispanic populations. We explored barriers and facilitators to LCS from the perspectives of screening-eligible patients and clinicians.

We conducted semi-structured interviews in English or Spanish (per participant preference) with 22 Black or Hispanic patients who had completed at least one LCS exam and 22 clinicians (20 primary care, two pulmonologists) from two safety-net hospitals in Massachusetts. Interview guides were informed by the Consolidated Framework for Implementation Research (CFIR). Patient interviews explored perceptions of LCS, psychological and logistical barriers, and facilitators to LCS engagement. Clinicians were asked about LCS communication, perceived patient barriers, and system-level challenges. Transcripts were analyzed using a hybrid inductive-deductive thematic analysis.

Many patients were unaware that the scan they completed was for LCS or did not recall discussing LCS with a clinician. Patients commonly reacted with fear upon first hearing the term "lung cancer screening," worrying they might have cancer, which was related to smoking-associated stigma. While patients mentioned barriers such as transportation and competing health demands, most felt they could attend appointments if informed. Clinicians, however, often cited logistical barriers and unmet social needs as key obstacles to LCS among Black and Hispanic patients. When probed further, clinicians were uncertain of the impact of smoking-associated stigma and cancer fear on patients' LCS engagement. Both patients and clinicians suggested that patient navigation could support patients through the LCS process.

Our findings highlight a disconnect between clinicians' focus on unmet social needs and patients' emphasis on emotional and psychological factors-particularly stigma and fear-as barriers to LCS. Interventions to improve LCS uptake in Black and Hispanic communities must address both logistical and psychological challenges, incorporating patient navigation to promote equitable LCS.