Abstract C155: Characteristics associated with patient activation and medical mistrust among lung cancer screening eligible patients in a multilevel intervention

Abstract Introduction: Lung cancer is the leading cause of cancer-related mortality in the US, with over 124,000 deaths expected in 2025. Yet, lung cancer screening (LCS) utilization is poor (∼20%), and there are racial and socioeconomic disparities in completion rates. The causes of low LCS uptake are multifactorial. Low patient activation and high medical mistrust, experienced by groups impacted by cancer disparities, have strong associations with screening behavior. We examined characteristics associated with patient activation and medical mistrust in a sample of LCS-eligible patients participating in a multilevel intervention trial. Methods: This analysis uses baseline data from a quasi-experimental study testing the effects of a provider- and patient-level intervention on equitably increasing LCS awareness and utilization. LCS-eligible patients (50-80 years old, 20+ pack-years, currently smoking or quit <15 years ago, no history of lung cancer, non-adherent to LCS) are identified by the electronic health record, contacted, and enrolled. Patient activation is scored as low (0-79), moderate (80-94), or high (95-100) and refers to one’s confidence and ability in managing their health and healthcare. Medical mistrust, a lack of trust or confidence in the healthcare system, is scored with higher values indicating higher levels of medical mistrust (1-5). Social determinants of health were measured using: 1) the 2019 Social Deprivation Index (low (<50) or high (50-100)) based on ZIP code and 2) social needs using four questions assessing economic stability, food, housing, and safety. We used bivariate analyses (chi-square, ANOVA, correlation) to determine the demographic characteristics and social determinants of health associated with patient activation and medical mistrust. Results: In our majority (57%) African American sample (N=134), 27% of participants reported being aware of LCS prior to enrolling in the trial. Most (59%) participants reported low patient activation, 29% moderate activation, and 12% high activation. The average medical mistrust score was 1.7 (SD=0.6; range: 1.0-3.4). Regarding patient activation, participants experiencing high social deprivation were more likely to report moderate activation vs. low or high activation (p=0.07). Higher medical mistrust was associated with endorsing one or more social needs (M=1.9, SD=0.7; p<0.05), having a high school degree or less (M=1.9, SD=0.7, p<0.05), and younger age (r=-0.31, p<0.05). Conclusions: Our findings suggest that patients with moderate patient activation and higher medical mistrust are more likely to report higher deprivation, more social needs, and lower education. This suggests the need for targeted interventions for eligible patients with low to moderate patient activation, and higher levels of medical mistrust, to reduce LCS disparities. This analysis will aid in understanding predictors of change in patient activation upon the trial’s conclusion. Citation Format: Anu Sangraula, Agnes K. Arianto, Kathryn L. Taylor, Aanem Hasnie, Ruth Morgan, Shannon Melvin, Randi M. Williams. Characteristics associated with patient activation and medical mistrust among lung cancer screening eligible patients in a multilevel intervention [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C155.