Lost to follow up?: A qualitative study of why some patients do not pursue lung cancer screening

Although national guidelines recommend lung cancer screening for adults at high risk, only a small proportion of eligible adults in the US have been screened. The goal of this study was to understand barriers to screening among a specific but important population: patients who have been referred for screening, but who have not completed the test. We used semi-structured interviews to explore barriers to screening among patients at two academic, safety-net primary care practices. We included patients who had been referred for screening at least 6 months prior but who had not completed the test. Among interviewees (N = 16) a consistent theme was a lack of knowledge about the purpose and process of screening. Despite being referred for lung cancer screening, participants expressed that they knew little about how screening was performed or what it was intended to achieve. Preferences and values also played a role in why some participants did not return for screening. Our findings suggest that lack of knowledge about screening is an important barrier to use, as patients are unlikely to prioritize a test if they know little about it.