ATTITUDES TOWARD SCREENING AND LUNG CANCER RISK PERCEPTIONS AMONG VETERANS INVITED TO AND SCHEDULING LUNG CANCER SCREENING

Purpose: We evaluated the effects of lung cancer screening (LCS) on Veterans’ attitudes towards screening and lung cancer risk perceptions at the Minneapolis VA Health Care System (MVAHCS).

Method: In 2014 the VHA initiated the LCS Clinical Demonstration Project, offering LCS to eligible Veterans. Due to radiology resource restrictions, LCS-eligible Veterans were randomly assigned to either a proactive invitation to schedule an LCS CT (LCS Group) or to usual care (UC), which included LCS only if referred by the primary care provider. We surveyed both groups 3 months post-randomization to assess Veterans’ attitudes towards screening (using Likert-scaled responses to 12 statements, from 'strongly disagree' to 'strongly agree') and lung cancer risk perceptions (both absolute and compared to other current or former smokers of a similar age who had smoked about the same amount). We compared outcomes: 1) between LCS Group and UC, and 2) within the LCS Group, between Veterans scheduling an LCS CT (LCS-Y) and those not (LCS-N).

Result: Among the 926 patients randomized to the LCS Group, 384 (41.5%) responded to the survey; among the 462 randomized to UC, 205 (44.5%) responded. There were no statistically significant differences across the groups on attitudinal or risk measures. Additionally, there were no statistically significant differences across LCS-Y (N=115; 30%) and LCS-N (N=269; 70%) Veterans' lung cancer risk perceptions. However, LCS-Y Veterans had more positive attitudes towards LCS compared to LCS-N Veterans: 46.0% vs 17.7% strongly agreed with the statement ‘lung cancer screening makes sense to me’ (χ²=41.36, p<0.001), 32.2% vs 17.8% strongly agreed with the statement ‘lung cancer screening can help protect my health’ (χ²=12.99, p=0.011), and 15.7% vs 10.7% strongly disagreed with the statement ‘I would be just as healthy if I avoided lung cancer screening’ (χ²=20.25, p<0.001). LCS-Y Veterans also had higher LCS self-efficacy: 31.6% vs 12.4% strongly agreed with the statement ‘I am confident that lung cancer screening would be easy’ (χ²=30.09, p<0.001).

Conclusion: Neither proactive invitation nor scheduling an LCS CT had a significant impact on Veterans’ lung cancer risk perceptions. The insignificant difference in LCS Group and UC attitudes towards screening may indicate that the proactive invitation presented the risks and benefits of LCS in an unbiased way. However, and not surprisingly, there were more positive attitudes towards LCS expressed among Veterans actually scheduling LCS.