title: Patient Perspectives on Low-Dose Computed Tomography for Lung Cancer Screening, New Mexico, 2014.
abstract: National guidelines call for annual lung cancer screening for high-risk smokers using low-dose computed tomography (LDCT). The objective of our study was to characterize patient knowledge and attitudes about lung cancer screening, smoking cessation, and shared decision making by patient and health care provider.
  
  
  
  We conducted semistructured qualitative interviews with patients with histories of heavy smoking who received care at a Federally Qualified Health Center (FQHC Clinic) and at a comprehensive cancer center-affiliated chest clinic (Chest Clinic) in Albuquerque, New Mexico. The interviews, conducted from February through September 2014, focused on perceptions about health screening, knowledge and attitudes about LDCT screening, and preferences regarding decision aids. We used a systematic iterative analytic process to identify preliminary and emergent themes and to create a coding structure.
  
  
  
  We reached thematic saturation after 22 interviews (10 at the FQHC Clinic, 12 at the Chest Clinic). Most patients were unaware of LDCT screening for lung cancer but were receptive to the test. Some smokers said they would consider quitting smoking if their screening result were positive. Concerns regarding screening were cost, radiation exposure, and transportation issues. To support decision making, most patients said they preferred one-on-one discussions with a provider. They also valued decision support tools (print materials, videos), but raised concerns about readability and Internet access.
  
  
  
  Implementing lung cancer screening in sociodemographically diverse populations poses significant challenges. The value of tobacco cessation counseling cannot be overemphasized. Effective interventions for shared decision making to undergo lung cancer screening will need the active engagement of health care providers and will require the use of accessible decision aids designed for people with low health literacy.
authors.affiliation: Professor, Department of Pediatrics, University of New Mexico School of Medicine, 1 University of New Mexico, MSC 10 5590, Albuquerque, NM 87131. Email: smishra@salud.unm.edu.
authors.forename: Shiraz I
authors.initials: SI
authors.lastname: Mishra
authors.affiliation: Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Sussman
authors.affiliation: Clinical and Translational Science Center, University of New Mexico, Albuquerque, New Mexico.
authors.forename: Ambroshia M
authors.initials: AM
authors.lastname: Murrietta
authors.affiliation: Department of Anthropology, University of Maryland, College Park, Maryland.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Getrich
authors.affiliation: Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: Robert
authors.initials: R
authors.lastname: Rhyne
authors.affiliation: University of New Mexico Comprehensive Cancer Center, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Crowell
authors.affiliation: Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Taylor
authors.affiliation: Informed Medical Decisions Foundation/Healthwise, Boston, Massachusetts.
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: Reifler
authors.affiliation: Informed Medical Decisions Foundation/Healthwise, Boston, Massachusetts.
authors.forename: Pamela H
authors.initials: PH
authors.lastname: Wescott
authors.affiliation: Division of Pulmonary Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ali I
authors.initials: AI
authors.lastname: Saeed
authors.affiliation: Department of Medicine, University of Iowa Carver College of Medicine, University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Hoffman
mesh_terms: D000368:Aged; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009516:New Mexico; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000628:therapy*; D016540:Smoking Cessation; D014057:Tomography, X-Ray Computed