ASPO Abstracts
Pathways to Lung Cancer Diagnosis in Non-Screened Individuals
Category: Behavioral Science & Health Communication
Conference Year: 2022
Abstract Body:
Purpose: Early detection of lung cancer is associated with better prognosis, but screening is recommended only for those at highest risk, and uptake among that population is low. We sought to characterize pathways to lung cancer diagnosis among unscreened individuals.Methods: Participants were English-speaking individuals with lung cancer who received care at the University of Utah (n=14). We preferentially invited never-smokers and individuals ineligible for asymptomatic screening. Semi-structured interviews explored participants' narratives of their cancer diagnoses. Interviews were audio-recorded, transcribed, and coded in Dedoose in two stages. First, we conducted deductive coding using the first three intervals of the Models of Pathways to Treatment (MPT) framework: appraisal, help-seeking, and diagnostic. Second, we conducted inductive coding to identify themes within each interval, including factors that facilitated or delayed diagnosis. Coding was completed by two independent reviewers who discussed for consensus.Results: The majority of participants were ever smokers (n=8), female (n=9), and non-Hispanic White (n=13). Median age at diagnosis was 66 years (range 44-81), and median time between diagnosis and interview was 2.5 years (range 1-10). No one had undergone screening; 12 participants were ineligible as never-smokers (n=6) or former-smokers with <30 pack years (n=6). Barriers to diagnosis identified in the MPT intervals included: self-dismissal of symptoms, most commonly persistent cough (appraisal), difficulty accessing providers (help-seeking), and dismissal or misattribution of symptoms by providers (diagnostic). Factors that facilitated diagnosis included: proactive acknowledgment of symptoms by individuals or their support networks (appraisal), self-advocating for testing (diagnosis), and referral to imaging at presentation of symptoms (diagnosis).Conclusions: Most opportunities to reduce time to diagnosis occurred during the appraisal and diagnostic intervals. Educating patients, especially those ineligible for screening, to follow-up with healthcare providers on persistent coughs and to self-advocate for imaging may lead to earlier lung cancer diagnoses.
Keywords: lung cancer, pathways to diagnosis