School of Social Science, The University of Queensland, St Lucia, Queensland, Australia.
The Prince Charles Hospital, Chermside, Queensland, Australia.
Health Soc Care Community. 2022 Nov;30(6):e5259-e5269. doi: 10.1111/hsc.13945. Epub 2022 Jul 27.
Low-dose computed tomography lung cancer screening has mortality benefits. Yet, uptake has been low. To inform strategies to better deliver and promote screening, in 2018, we interviewed 27 long-term smokers immediately following lung cancer screening in Australia, prior to receiving scan results. Existing lung screening studies employ the Health Belief Model. Reflecting growing acknowledgement of the centrality of emotions to screening uptake, we draw on psychological and sociological theories on emotions to thematically and abductively analyse the emotional dimensions of lung cancer screening, with implications for screening promotion and delivery. As smokers, interviewees described feeling stigmatised, with female participants internalising and male participants resisting stigma. Guilt and fear related to lung cancer were described as screening motivators. The screening itself elicited mild positive emotions. Notably, interviewees expressed gratitude for the care implicitly shown through lung screening to smokers. More than individual risk assessment, findings suggest lung screening campaigns should prioritise emotions. Peer workers have been found to increase cancer screening uptake in marginalised communities, however the risk to confidentiality-especially for female smokers-limits its feasibility in lung cancer screening. Instead, we suggest involving peer consultants in developing targeted screening strategies that foreground emotions. Furthermore, findings suggest prioritising humanistic care in lung screening delivery. Such an approach may be especially important for smokers from low socioeconomic backgrounds, who perceive lung cancer screening and smoking as sources of stigma and face a higher risk of dying from lung cancer and lower engagement with screening.
低剂量计算机断层扫描肺癌筛查可降低死亡率。然而，其接受程度仍然较低。为了制定更好的策略来提供和推广筛查，我们在 2018 年澳大利亚进行肺癌筛查后，在患者收到扫描结果之前，对 27 名长期吸烟的患者进行了采访。现有的肺癌筛查研究采用健康信念模型。反映出对情绪在筛查参与中的核心作用的认识不断增强，我们借鉴了关于情绪的心理学和社会学理论，对肺癌筛查的情绪维度进行了主题和推断性分析，为筛查推广和实施提供了启示。作为吸烟者，受访者表示感到被污名化，女性参与者内化了这种污名化，而男性参与者则抵制了这种污名化。与肺癌相关的内疚感和恐惧感被描述为筛查的动机。筛查本身引发了轻微的积极情绪。值得注意的是，受访者对通过肺癌筛查向吸烟者表示关怀表示感激。研究结果表明，与个体风险评估相比，肺癌筛查活动应优先考虑情绪因素。同伴工作人员已被发现可以增加边缘化社区的癌症筛查参与度，但是保密性风险（特别是对于女性吸烟者）限制了其在肺癌筛查中的可行性。相反，我们建议在制定有针对性的筛查策略时，让同伴顾问参与其中，并将情绪放在首位。此外，研究结果表明，在肺癌筛查实施过程中应优先考虑人性化关怀。对于来自社会经济背景较低的吸烟者来说，这种方法可能尤其重要，因为他们认为肺癌筛查和吸烟是污名化的来源，并且面临更高的死于肺癌的风险和更低的参与筛查的可能性。
