Decisional Needs of African American Smokers for Lung Cancer Screening
Williams, Randi Marie
Knott, PhD, Cheryl L.
MetadataShow full item record
The burden of lung cancer is significant for African Americans, especially African American men, who have the highest lung cancer death rates compared to all racial and ethnic groups. In 2013, the United States Preventive Services Task Force (USPSTF) provided a recommendation for annual screening using low-dose computed tomography (LDCT) due to the disease-specific mortality benefit. Given the test’s limitations (e.g., false positives, radiation exposure) the USPSTF and other medical organizations endorse informed decision-making, a process by which individuals weigh the benefits and harms of the test and make a decision about usage. The recent release of the screening guidelines and promotion of informed decision-making provides a timely opportunity to examine patients’ decision-making processes around lung cancer screening. The purpose of this study was to describe aspects of decision-making for lung cancer screening including knowledge and awareness about LDCT, values related to screening, uncertainty about the test, and decision-making preferences among African American adult smokers. Additionally, this study examined the extent to which decision-making components are associated with screening intentions. The Ottawa Decision Support Framework provided the conceptual framework for this study, positing that patients’ decisional needs (e.g., knowledge, personal values) impact decisional quality (e.g., being informed, low regret) which ultimately influences behavior (e.g., use of health services). First, patient and provider key informant interviews (N=9) were conducted to inform the development of a decisional values measure. Next, a survey was administered to African American (N=119) long-term smokers. Among the study sample, lung cancer screening awareness and knowledge were limited (Mean=7.1 out of 15). Individuals were experiencing uncertainty about the screening decision, but lower decisional conflict was associated with greater likelihood of talking with friends about LDCT as well as screening intention (p’s<.05). This is one of the first studies to describe the decisional needs of an entirely African American sample of smokers for lung cancer screening using LDCT and to examine the associations between these components of decision-making and screening intentions. Findings have implications for addressing the decisional needs of African American smokers to promote informed decision-making for LDCT and to thwart further cancer inequities.