Division of Primary Care, University of Nottingham, Nottingham, UK.
Tayside Clinical Trials Unit, University of Dundee, Dundee, UK.
BMC Public Health. 2018 Nov 20;18(1):1276. doi: 10.1186/s12889-018-6211-1.
The promotion of smoking cessation within lung cancer screening could lead to benefits for smoking-related disease and improve cost-effectiveness of screening. Little is known about how smokers respond to lung cancer screening and how this impacts smoking behaviour. We aimed to understand how lung cancer screening influences individual motivations about smoking, including in those who have stopped smoking since screening.
Thirty one long-term smokers aged 51-74 took part in semi-structured interviews about smoking. They had been screened with the EarlyCDT-Lung Test (13 positive result; 18 negative) as part of the Early Cancer Detection Test Lung Cancer Scotland Study. They were purposively sampled for interview based on their self-reported post-screening smoking behaviour. Eleven participants had stopped smoking since screening. Verbatim interview transcripts were analysed using thematic analysis.
Two key overarching themes were interpretations of screening test results and emotional responses to those interpretations. Participants' understanding of the risk implied by their test result was often inaccurate, for example a negative result interpreted as an 'all-clear' from lung cancer and a positive result as meaning lung cancer would definitely develop. Those interpretations led to emotional responses (fear, shock, worry, relief, indifference) influencing motivations about smoking. Other themes included a wake-up call causing changes in perceived risk of smoking-related disease, a feeling that now is the time to stop smoking and family influences. There was no clear pattern in smoking motivations in those who received positive or negative test results. Of those who had stopped smoking, some cited screening experiences as the sole motivation, some cited screening along with other coinciding factors, and others cited non-screening reasons. Cues to change were experienced at different stages of the screening process. Some participants indicated they underwent screening to try and stop smoking, while others expressed little or no desire to stop.
We observed complex and individualised motivations about smoking following lung cancer screening. To be most effective, smoking cessation support in this context should explore understanding of screening test results and may need to be highly tailored to individual emotional responses to screening.
在肺癌筛查中推广戒烟可以为与吸烟相关的疾病带来益处，并提高筛查的成本效益。但目前人们对吸烟者对肺癌筛查的反应知之甚少，也不知道这对他们的吸烟行为会产生怎样的影响。我们旨在了解肺癌筛查如何影响个人对吸烟的动机，包括那些自筛查以来已经戒烟的人。
31 名年龄在 51-74 岁的长期吸烟者参加了关于吸烟的半结构化访谈。他们曾参加过苏格兰早期癌症检测肺癌筛查的早期 CDT-Lung 测试（13 例阳性结果，18 例阴性结果）。他们是根据自我报告的筛查后吸烟行为，有目的地选择参加访谈的。其中 11 名参与者在筛查后已经戒烟。对逐字逐句的访谈记录进行主题分析。
两个主要的主题是对筛查测试结果的解释和对这些解释的情绪反应。参与者对测试结果所暗示的风险的理解往往是不准确的，例如，阴性结果被解释为“肺癌清零”，而阳性结果则意味着肺癌肯定会发展。这些解释导致了对吸烟动机的情绪反应（恐惧、震惊、担忧、宽慰、漠不关心）。其他主题包括一个警钟，使人们对吸烟相关疾病的风险感知发生变化，一种感觉是现在是戒烟的时候了，以及家庭的影响。在收到阳性或阴性测试结果的人中，吸烟动机没有明显的模式。那些已经戒烟的人，有些人将筛查经历作为唯一的动机，有些人则将筛查与其他同时发生的因素一起作为动机，还有些人则以非筛查原因作为动机。改变的线索在筛查过程的不同阶段都有体验到。一些参与者表示，他们进行筛查是为了尝试戒烟，而另一些人则表示他们几乎没有或根本没有戒烟的愿望。
我们观察到肺癌筛查后吸烟的动机是复杂和个体化的。为了达到最有效的效果，在这种情况下，戒烟支持应该探讨对筛查测试结果的理解，并且可能需要根据个人对筛查的情绪反应进行高度定制。
