title: A qualitative study exploring why individuals opt out of lung cancer screening.
abstract: Lung cancer screening with annual low-dose computed tomography is relatively new for long-term smokers in the USA supported by a US Preventive Services Task Force Grade B recommendation. As screening programs are more widely implemented nationally and providers engage patients about lung cancer screening, it is critical to understand behaviour among high-risk smokers who opt out to improve shared decision-making processes for lung cancer screening.
  
  
  
  The purpose of this study was to explore the reasons for screening-eligible patients' decisions to opt out of screening after receiving a provider recommendation.
  
  
  
  Semi-structured qualitative telephone interviews were performed with 18 participants who met lung cancer screening criteria for age, smoking and pack-year history in Washington State from November 2015 to January 2016. Two researchers with cancer screening and qualitative methodology expertise conducted data analysis using thematic content analytic procedures from audio-recorded interviews.
  
  
  
  Five primary themes emerged for reasons of opting out of lung cancer screening: (i) Knowledge Avoidance; (ii) Perceived Low Value; (iii) False-Positive Worry; (iv) Practical Barriers; and (v) Patient Misunderstanding.
  
  
  
  The participants in our study provided insight into why some patients make the decision to opt out of low-dose computed tomography screening, which provides knowledge that can inform intervention development to enhance shared decision-making processes between long-term smokers and their providers and decrease decisional conflict about screening.
authors.affiliation: Indiana University School of Nursing, Science of Nursing Care Department, Indianapolis, IN, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Carter-Harris
authors.affiliation: Group Health Research Institute, Seattle, WA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Brandzel
authors.affiliation: Group Health Research Institute, Seattle, WA, USA.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Wernli
authors.affiliation: Fred Hutchinson Cancer Research Center, Hutchinson Institute for Cancer Outcomes Research, Seattle, WA, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Roth
authors.affiliation: Group Health Research Institute, Seattle, WA, USA.
authors.forename: Diana S M
authors.initials: DSM
authors.lastname: Buist
mesh_terms: D000368:Aged; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D036301:Qualitative Research; D012907:Smoking / Q000009:adverse effects; D057545:Social Stigma; D013689:Telephone / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed; D014861:Washington
keywords: Decision making and qualitative research; cancer screening; lung cancer; patients; primary health care