Healthcare Staff Perspectives on Improving Access to and Receipt of Lung Cancer Screening

Abstract Background Lung cancer screening (LCS) rates remain disproportionately low compared with screening rates for other cancers, especially among marginalized populations. Improving uptake is challenging due to multilevel barriers involving the healthcare system, clinical environments, and interest holders. Although prior research has examined barriers from the perspectives of patients and healthcare providers, there is a paucity of research identifying LCS barriers from the perspective of healthcare staff (e.g., nurses) who help carry out screening processes. Objective To understand multilevel barriers to equitable LCS access and receipt from the perspectives of healthcare staff. Design This was a qualitative study of 15 semi-structured interviews. Participants were US healthcare staff members (e.g., nurses or medical assistants). Participants completed virtual semi-structured interviews eliciting their perspectives of LCS barriers across each level of the Health Equity Implementation Framework (HEIF), a framework for assessing determinants of equitable LCS implementation across multiple levels (e.g., patient, provider, clinical encounter, and inner/outer healthcare system contexts). Interview transcripts were analyzed using template analysis and a combined deductive-inductive qualitative approach. Key Results Most healthcare staff had little clinical knowledge about LCS but agreed that LCS has benefits for early detection. Participants identified barriers to equitable LCS across each HEIF level, such as patient concerns related to claustrophobia, limited provider time to discuss LCS, patient and provider LCS unawareness, inadequate media coverage, and limited transportation options. Participants also described provider bias or discrimination, smoking-related stigma, healthcare mistrust, cost concerns, and societal disregard for older, under-resourced, and/or marginalized populations as barriers affecting equity in LCS uptake. Several identified that barriers were interconnected and spanned multiple HEIF levels. Conclusions Healthcare staff uniquely described barriers to LCS across all levels of the HEIF. Multilevel interventions, especially those aimed at higher HEIF levels, may reduce LCS barriers and inequity.