Access to Lung Cancer Screening Among American Indians and Alaska Natives: A Qualitative Study.

Publication Title

Chest

Authors

Allison C Welch, Department of Thoracic Surgery and Interventional Pulmonology, Swedish Medical Center and Cancer Institute, Seattle, WA.Follow
Sara M London
Candice Wilshire, Department of Thoracic Surgery and Interventional Pulmonology, Swedish Medical Center and Cancer Institute, Seattle, WA.Follow
Christopher R Gilbert
Dedra Buchwald
Gary Ferguson
Cole Allick
Jed A Gorden, Department of Thoracic Surgery and Interventional Pulmonology, Swedish Medical Center and Cancer Institute, Seattle, WA. Electronic address: jed.gorden@swedish.org.Follow

Document Type

Article

Publication Date

10-28-2023

Keywords

ndians; North American; attitudes; early detection of cancer; health knowledge; lung neoplasms; practice; qualitative research.; washington; swedish; swedish cancer; swedish thoracic surgery; diversity

Abstract

BACKGROUND: Lung cancer is the leading cause of cancer mortality among American Indians and Alaska Natives. American Indians and Alaska Native people use commercial tobacco products at much higher rates compared with all other races and ethnicities. Moreover, they show lower adherence to cancer screening guidelines.

RESEARCH QUESTION: How do American Indian and Alaska Native adults perceive and use lung cancer screening?

STUDY DESIGN AND METHODS: We conducted a study in which we recorded and transcribed data from three focus groups consisting of American Indians and Alaska Native adults. Participants were recruited through convenience sampling at a national health conference. Transcripts were analyzed by inductive coding.

RESULTS: Participants (n = 58) of 28 tribes included tribal Elders, tribal leaders, and non-Native volunteers who worked with tribal communities. Limited community awareness of lung cancer screening, barriers to lung cancer screening at health care facilities, and health information-seeking behaviors emerged as key themes in discussions. Screening knowledge was limited except among people with direct experiences of lung cancer. Cancer risk factors such as multigenerational smoking were considered important priorities to address in communities. Limited educational and diagnostic resources are significant barriers to lung cancer screening uptake in addition to limited discussions with health care providers about their cancer risk.

INTERPRETATION: Limited access to and awareness of lung cancer screening must be addressed. American Indians and Alaska Native adults use several health information sources unique to tribal communities, and these should be leveraged in designing screening programs. Equitable partnerships between clinicians and tribes are essential in improving knowledge and use of lung cancer screening.

Area of Special Interest

Cancer

Specialty/Research Institute

Oncology

Specialty/Research Institute

Pulmonary Medicine

DOI

10.1016/j.chest.2023.10.025