Patient experience of and psychological responses to lung cancer screening

Background

Screening high-risk patients for lung cancer using low dose CT scans has shown to reduce deaths from lung cancer by 20% compared with x-ray.

This year, the UK National Screening Committee is reviewing evidence from European trials to decide whether to recommend screening in the UK. Local screening pilots (targeted lung health checks) have already begun.

The experience of patients should inform the way screening is delivered and communicated, to promote psychological wellbeing, manage distress associated with abnormal results that require surveillance, and motivate positive behaviour change.

We plan to directly translate results into an evidence based training intervention module for health professionals delivering lung cancer screening that could ultimately be disseminated to UK screening centres and primary care.

Dr. Waller and Dr. Quaife, Health Behaviour Research Centre, University College London

What is the problem to be addressed?

Psychological outcomes of lung cancer screening have been measured with previous participants, and several of these studies warn of short-term screening related stress.

Abnormal lung cancer screening results are common because, as well as detecting lung cancer, LDCT scans also detect abnormalities that look like early cancers bit are, currently, harmless. In the National Lung Screening Trial, 39% of participants received at least one abnormal result, but after further scans, the majority (96%) were found to be harmless.

Studies have shown that trial participants receiving abnormal or indeterminate results were vulnerable to distress. This indeterminate group needed further scans and monitoring to make sure the findings were not serious. Patients’ experiences and interpretations of abnormal results must be understood so that the ways in which healthcare professionals’ communicate can be tailored to manage patients’ anxiety.

Some researchers warn that a lung cancer screening programme could encourage people to carry on smoking, or become less concerned about symptoms of lung cnacer the might develop in between scans, causing them to delay going to the GP.

Our preliminary data shows that some older people who have smoked heavily feel a clear result would empower them to stop smoking and take back control of their health.

Furthermore, screening provides to opportunity to raise awareness of lung cancer symptoms and encourage prompt help-seeking. In depth research is needed to identify and explore the full range of psychological responses patients might have to the screening process and the different results, in order to find out how to encourage positive responses and behaviour change.

Expected findings and potential impact

We predict that the reassurance offered by lung cancer screening will lower distress and lung cancer-related worry among high-risk patients, compared with high-risk individuals in the general population.

We expect to identify vulnerable patient sub-groups and learn important insights from their experience of the screening process that can be put into practice to optimize wellbeing and improve the experiences of future patients.

We expect to identify many different positive and negative psychological responses to screening, and factors that can be changed in screening communication and taught effectively by the online training module we develop.

This research could maximize patient benefit from any future lung cancer screening programme by guiding healthcare professionals in delivering a service that promotes psychological wellbeing, minimize distress among patients with abnormal findings, and promote positive behaviour changes in smoking and early detection.

It will also contribute to the scientific evidence base for screening implementation and set the agenda for future patient-focused research in lung cancer screening.

We plan to directly translate results into an evidence based training intervention module for health professionals delivering lung cancer screening that could ultimately be disseminated to UK screening centres and primary care.

Lead researchers: Dr Jo Waller and Dr Samantha Quaife | Location: Health Behaviour Research Centre, University College London | Type of research: Patient experience