title: Barriers to uptake among high-risk individuals declining participation in lung cancer screening: a mixed methods analysis of the UK Lung Cancer Screening (UKLS) trial.
abstract: OBJECTIVE
  The current study aimed to identify the barriers to participation among high-risk individuals in the UK Lung Cancer Screening (UKLS) pilot trial.
  
  
  METHODS
  The UKLS pilot trial is a randomised controlled trial of low-dose CT (LDCT) screening that has recruited high-risk people using a population approach in the Cambridge and Liverpool areas.
  
  
  METHODS
  High-risk individuals aged 50-75 years were invited to participate in UKLS. Individuals were excluded if a LDCT scan was performed within the last year, if they were unable to provide consent, or if LDCT screening was unable to be carried out due to coexisting comorbidities.
  
  
  METHODS
  Statistical associations between individual characteristics and UKLS uptake were examined using multivariable regression modelling. In those who completed a non-participation questionnaire (NPQ), thematic analysis of free-text data was undertaken to identify reasons for not taking part, with subsequent exploratory linkage of key themes to risk factors for non-uptake.
  
  
  RESULTS
  Comparative data were available from 4061 high-risk individuals who consented to participate in the trial and 2756 who declined participation. Of those declining participation, 748 (27.1%) completed a NPQ. Factors associated with non-uptake included: female gender (OR=0.64, p<0.001), older age (OR=0.73, p<0.001), current smoking (OR=0.70, p<0.001), lower socioeconomic group (OR=0.56, p<0.001) and higher affective risk perception (OR=0.52, p<0.001). Among non-participants who provided a reason, two main themes emerged reflecting practical and emotional barriers. Smokers were more likely to report emotional barriers to participation.
  
  
  CONCLUSIONS
  A profile of risk factors for non-participation in lung screening has emerged, with underlying reasons largely relating to practical and emotional barriers. Strategies for engaging high-risk, hard-to-reach groups are critical for the equitable uptake of a potential future lung cancer screening programme.
  
  
  BACKGROUND
  The UKLS trial was registered with the International Standard Randomised Controlled Trial Register under the reference 78513845.
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, UK.
authors.forename: Noor
authors.initials: N
authors.lastname: Ali
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, UK.
authors.forename: Kate J
authors.initials: KJ
authors.lastname: Lifford
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, UK.
authors.forename: Ben
authors.initials: B
authors.lastname: Carter
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, UK Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, The University of Liverpool Cancer Research Centre, Liverpool, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: McRonald
authors.affiliation: Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, The University of Liverpool Cancer Research Centre, Liverpool, UK.
authors.forename: Ghasem
authors.initials: G
authors.lastname: Yadegarfar
authors.affiliation: Respiratory Medicine Unit, David Evans Centre, Nottingham University Hospitals, Nottingham, UK.
authors.forename: David R
authors.initials: DR
authors.lastname: Baldwin
authors.affiliation: Centre for Population Health Sciences, Medical School, Edinburgh, UK.
authors.forename: David
authors.initials: D
authors.lastname: Weller
authors.affiliation: Department of Radiology, Royal Brompton Hospital, London UK.
authors.forename: David M
authors.initials: DM
authors.lastname: Hansell
authors.affiliation: Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, London, UK.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Duffy
authors.affiliation: Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, The University of Liverpool Cancer Research Centre, Liverpool, UK.
authors.forename: John K
authors.initials: JK
authors.lastname: Field
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Brain
mesh_terms: D000367:Age Factors; D000368:Aged; D055088:Early Detection of Cancer; D005239:Fear; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D011829:Radiation Dosage; D045808:Refusal to Participate / Q000523:psychology; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed / Q000379:methods*; D006113:United Kingdom
keywords: Barriers; High-risk; Lung cancer; Screening; UKLS