Attitudes to participation in a lung cancer screening trial: a qualitative study
- Deesha Patel1,
- Ajiri Akporobaro1,
- Nyasha Chinyanganya2,
- Allan Hackshaw3,
- Clive Seale1,
- Stephen G Spiro4,
- Chris Griffiths1 on behalf of the Lung-SEARCH Investigators*
- 1Centre for Primary Care and Public Health, Blizard Institute, Queen Mary, University of London, London, UK
- 2Department of Thoracic Medicine, University College London Hospital NHS Foundation Trust, London, UK
- 3Cancer Research UK and University College London Cancer Trials Centre, London, UK
- 4Royal Brompton Hospital, London, UK
- Correspondence to Professor Chris Griffiths, Centre for Primary Care and Public Health, Blizard Institute, Yvonne Carter Building, London E1 2AB, UK;
Contributors CG and SS had the original idea for the study. The design was elaborated by all the authors. DP, AA and CG carried out interviews and analyses. All the LUNGSEARCH recruitment teams supported recruitment to the study. All authors commented critically on the analysis and the drafts of the paper.
- Received 18 February 2011
- Accepted 14 October 2011
- Published Online First 21 November 2011
Background Earlier diagnosis of lung cancer is key to reducing mortality. New evidence suggests that smokers have negative attitudes to screening and participation in lung cancer screening trials is poor (<1 in 6 of those eligible). Understanding participation is important since uptake in screening trials is likely to predict uptake in screening programmes. A qualitative study of people accepting and declining participation in the Lung-SEARCH screening trial was conducted. Two questions were addressed: Are the screening methods offered acceptable to patients? Why do some people take part and others decline?
Methods The qualitative study used semi-structured interviews with 60 respondents from three groups: (a) trial participants providing an annual sputum sample; (b) trial participants with a sputum sample showing abnormal cytology and thus undergoing annual CT scanning and bronchoscopy; and (c) those declining trial participation.
Results Most respondents (48/60, 80%) viewed sputum provision, CT scanning and bronchoscopy as largely acceptable. Those declining trial participation described fear of bronchoscopy, inconvenience of travelling to hospitals for screening investigations and perceived themselves as having low susceptibility to lung cancer or being too old to benefit. Patients declining participation discounted their risk from smoking and considered negative family histories and good health to be protective. Four typological behaviours emerged within those declining: ‘too old to be bothered’, ‘worriers’, ‘fatalists’ and ‘avoiders’.
Conclusion Sputum provision, CT scanning and bronchoscopy are largely acceptable to those participating in a screening trial. However, the decision to participate or decline reflects a complex balance of factors including acceptability and convenience of screening methods, risk perception, altruism and self-interest. Improving practical and changing cognitive aspects of participation will be key to improving uptake of lung cancer screening.
- lung cancer
- lung cancer chemotherapy
- non-small cell lung cancer
- small cell lung cancer
- asthma guidelines
- asthma in primary care
- COPD mechanisms
- COPD epidemiology
- COPD exacerbations
- COPD pathology
Linked article 200898.
DP and AA contributed equally to this work.
Funding Cancer Research UK (CRUK) 2225.
Competing interests None.
Patient consent Obtained.
Ethics approval Ethics approval was provided by South West London Multi Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Our primary data is available for examination on request.