Quaife, SL; (2016) Lung cancer screening participation: attitudinal, socioeconomic and smoking-related factors. Doctoral thesis , UCL (University College London).

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Abstract

Socioeconomic and smoking-related biases in participation threaten the equity and effectiveness of any future UK lung cancer screening programme. This thesis used a mixed methods approach to investigate psychosocial and cognitive factors that might contribute to these biases, with the aim of identifying possible targets for intervention in screening communication strategies. This informed the design of screening invitation materials aimed at engaging low socioeconomic position (SEP) smokers with a screening offer, which were tested using a randomised controlled pilot trial. The findings of these studies suggest that the introduction of a lung cancer screening programme would be acceptable to older English adults. However, while there was high willingness to be screened (>91%), this was not matched by high uptake of screening in the pilot trial (55%). Chapters 4 to 7 showed that negative beliefs about outcomes and early detection for lung cancer were prevalent among participants recruited from low SEP communities, and associated with current smoking status. Compared with their non-smoking counterparts, smokers more commonly expressed fatalistic beliefs about risk, survival and treatment for lung cancer (including early stage disease), worried about lung cancer and the outcome of screening, and perceived smoking and lung cancer to be stigmatised. Intervention screening invitation materials were designed to improve uptake by minimising these factors but an early interim analysis of the pilot trial testing these materials showed no effect on uptake of lung cancer screening appointments (n=241; final target N=2000). Lower SEP smokers’ more negative expectations of risk, stigma, treatment and outcomes for lung cancer, particularly for older high risk adults, appear to undermine the salience and perceived personal benefit of lung cancer screening. Further work needs to be done to explore whether interventions can effectively modify these perceptions to improve engagement with screening among the very group most likely to benefit.

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