Reducing Stigma in Lung Cancer Screening: Co-Design of a Targeted Resource for Health Professionals in Australia

Organised lung cancer screening (LCS) programs are being developed worldwide in response to recent landmark trial evidence. Targeting high-risk individuals primarily based on smoking history, LCS faces challenges from smoking-related stigma, which can cause psychological harm and hinder participation. With limited interventions addressing this issue, this study aimed to co-design a communication-based strategy to reduce stigma in the LCS context.

Using best-practice co-design principles, this study involved workshops, focus groups, and interviews with 5 consumers (people eligible for LCS in Australia) and 44 health professionals and other experts (including clinicians, radiographers, behavioural scientists, and health managers). Participants were purposively sampled to achieve representation across key variables - e.g., smoking history for consumers, professional roles for experts. Consultation with experts was conducted as part of a larger project developing a suite of information materials for the National Lung Cancer Screening Program in Australia. Key literature and concurrent qualitative research with consumers (n = 24) also informed co-design. Qualitative data were analysed using abductive thematic analysis.

Early consultation identified the preferred format for the strategy as a resource targeted for health professionals involved in the LCS pathway. Resource content was iteratively revised, with three key themes developed: (1) Taking the onus off the individual; (2) Fostering understanding and empathy; (3) Positive framing. A lexicon guide promoting person-first and empowerment language was also included guided by previous literature. The final resource was a four-page A4 document for health professionals and LCS staff, designed to support effective, stigma-sensitive communication during LCS.

We co-designed a practical, scalable resource to reduce stigma for use in the Australian National Lung Cancer Screening Program, expected to ultimately reduce psychological harm for LCS participants and enhance screening participation. Future research should evaluate the resource as an implementation strategy for LCS uptake. Cultural adaptation and tailoring of the resource for specific populations considering intersectional stigmas is also needed.

We collaborated with a consumer advisor for the project's duration, including study design, co-facilitation of consumer workshops, analysis and manuscript writing.