1. Lung Cancer Screening: Do Individual Health Beliefs Matter?
Lisa Carter-Harris, PhD, RN, ANP-C1, James E. Slaven II, MS, MA2,
Patrick O. Monahan, PhD2, & Susan M. Rawl, PhD, RN, FAAN1
1Indiana University School of Nursing, Indianapolis, IN
2Indiana University School of Medicine, Department of Biostatistics, Indianapolis, IN
Background
Results
Results
Lung cancer kills more people worldwide than any other cancer.
Most die because they are diagnosed advanced with a 1% 5-year relative survival rate.
Lung cancer screening with low-dose computed tomography is a recent USPSTF recommendation for high-risk smokers.
New screening programs are being implemented, but factors that influence lung cancer screening participation in this population are unknown.
Health beliefs (perceived risk, perceived benefits, perceived barriers, and self-efficacy) have predicted cancer screening participation in other types of cancer, and may be predictive of lung cancer screening.
Table 1. Participant Sociodemographics
Overall (N=496)
Mean (SD)
Stages 1-4 (n=350)
Stages 5-7 (n=146)
Age
62.8 (5.8)
62.8 (6.1)
62.7 (5.2)
Pack-Years
50.5 (23.6)
49.9 (22.0)
52.1 (27.1)
N (%)
n (%)
Education:
Less than High School
20 ( 4.0)
17 ( 4.9)
3 ( 2.1)
High School Graduate
135 (27.3)
101 (28.9)
34 (23.5)
Some College
208 (42.0)
154 (44.0)
54 (37.2)
College Graduate
132 (26.7)
78 (22.3)
Race:
White
384 (77.7)
272 (78.2)
112 (76.7)
Black
103 (20.8)
72 (20.7)
31 (21.2)
Gender:
Male
191 (38.6)
127 (36.4)
64 (43.8)
Female
305 (61.5)
223 (63.7)
82 (56.2)
Income:
Less than $25K
155 (31.5)
119 (34.3)
36 (24.8)
$25K to $50K
227 (46.1)
161 (46.4)
66 (45.5)
Greater than $50K
110 (22.4)
67 (19.3)
43 (29.7)
Insurance Status:
Government-Sponsored
283 (57.2)
202 (57.7)
81 (55.9)
Private
192 (38.8)
134 (38.3)
58 (40.0)
Uninsured
14 ( 4.0)
6 ( 4.1)
Smoking Status:
Current Smoker
238 (48.5)
171 (49.3)
67 (46.5)
Former Smoker
254 (51.2)
179 (51.1)
79 (54.1)
Bivariable Model
Multivariable Model
Perceived Risk
1.01 (0.92, 1.11); p=0.8423
0.98 (0.89, 1.08); p=0.7706
Perceived Benefits
1.08 (1.03, 1.13); p=0.0018
1.07 (1.01, 1.13); p=0.0160
Perceived Barriers
0.98 (0.96, 0.99); p=0.0277
0.98 (0.96, 1.01); p=0.1201
Self-Efficacy
1.05 (1.02, 1.09); p=0.0034
1.03 (0.99, 1.08); p=0.1171
Outcomes are odds ratios (95% confidence intervals) for the odds of being in the Stage 5-7 group with p-value from logistic regression model.
Bivariable models are with only one predictor on the stage outcome variable. Multivariable model uses all four predictors at once on the stage outcome.
Conclusions
Purpose
Health beliefs have predicted cancer screening participation in other cancers like breast and colorectal cancer screening.
Results from this study support the importance of health belief model variables in the context of lung cancer screening in current and former long-term smokers.
Individuals who have an increased level of perceived benefit of and self-efficacy for lung cancer screening and decreased perceived barriers to lung cancer screening are more likely to screen for lung cancer.
Research is needed to explore these relationships more fully and to test the pathways in the conceptual model for lung cancer screening participation.
Identification of long-term current and former smokers who are more likely to screen for lung cancer will be useful for investigators interested in developing and testing interventions addressing health beliefs regarding lung cancer screening.
Ultimately, interventions tailored to the individual at risk for the development of lung cancer will benefit from designs that take individual health beliefs into consideration.
To examine the relationships between individual health beliefs (perceived risk of lung cancer, perceived benefits of, perceived barriers to, and self-efficacy for lung cancer screening) and lung cancer screening participation.
Participants who intend to or have been screened for lung cancer had higher mean scores on perceived benefits and self-efficacy, and lower means scores on perceived barriers compared to participants who have not been screened for lung cancer with LDCT.
Methods
Overall (n=496)
Mean (Range)
Stages 1-4 (n=350)
Stages 5-7 (n=146)
p-value
Total Perceived Risk
6.52 (2.26); (2-12)
6.51 (2.17); (2-12)
6.55 (2.47); (2-12)
0.8428
Total Perceived Benefits
17.09 (4.48); 18 (2-24)
16.68 (4.55); (2-24)
18.07 (4.14); (3-24)
0.0016*
Total Perceived Barriers
34.44 (9.08); 35 (7-65)
35.03 (8.58); (7-55)
33.05 (10.07); 34 (14-65)
0.0387*
Total Self-Efficacy
29.10 (6.25); 30 (1-36)
28.55 (6.55); (1-36)
30.38 (5.29); (8-36)
0.0012*
Descriptive, cross-sectional, correlational design using survey methodology.
Convenience sample of long-term current and former smokers eligible for lung cancer screening.
Conceptual Model
Acknowledgements
This work was supported by Grant 5T32 NR from the National Institute of Nursing Research Health Nursing and the Sigma Theta Tau International Iota Zeta Research Grant.