“As for stigma? … I don't think I'd be going to my next-door neighbor saying ‘I'm going for lung cancer screening’”: a qualitative study of the potential impacts of stigma during lung cancer screening in Australia

Abstract Introduction Lung cancer stigma is widespread, with consequences for patients psychologically and clinically. It can also be a barrier to lung cancer screening (LCS), though current evidence is limited. With LCS programs in development globally, this qualitative study explored the views, expectations, and potential impacts of stigma with people eligible for LCS before commencement of the Australian National LCS Program. Methods Participants met eligibility criteria for the Australian National LCS Program (asymptomatic of lung cancer; aged 50-70 years; currently smoking tobacco cigarettes or quit within 10 years; ≥30 pack-year smoking history). Abductive thematic analysis was used. Interview questions and theory-based codes were guided by the Health Stigma and Discrimination Framework. Results Twenty-four participants were interviewed; 50% (n = 12) were currently smoking and 25% (n = 6) were from culturally or linguistically diverse backgrounds. Most participants had high levels of education, high self-reported health literacy and lived in major cities. Four themes were identified: (1) Harmful narratives of personal responsibility and self-infliction; (2) Smoking stigma is a “necessary evil” and is inevitable in LCS; (3) Identity as part of the LCS cohort; (4) Previous perceptions of stigma in healthcare shape expectations for LCS. Conclusion Stigma in LCS – to some degree – is unavoidable given smoking-based eligibility criteria but may be reduced through: (1) messaging that dismantles industry-driven narratives around responsibility, blame and choice in tobacco use (e.g., by referencing external determinants of smoking behavior); (2) privacy and confidentiality of LCS participation; (3) communication training for LCS staff. Further work in priority communities considering intersectional stigmas is needed.