Lung Cancer Screening Knowledge and Its Association With Adherence to Annual LDCT Follow-up

Abstract

<jats:title>Abstract</jats:title> <jats:p>Introduction: Lung cancer screening (LCS) adherence rates are low in routine clinical settings (Silvestri et al. 2022). Research indicates a potential association between higher health literacy and better adherence to cancer screenings (Baccolini et al. 2022). Our study aimed to assess how knowledge of LCS influences adherence to recommendations of annual low-dose computed tomography (LDCT) scans. Methods: We conducted an analysis of data from a longitudinal, prospective observational study of patients enrolled from three health care systems after an LCS shared decision-making interaction with their clinician (Miranda et al. 2017). The study sample included patients who completed a baseline survey and underwent their initial LDCT. The primary outcome was adherence to recommendations for the annual LDCT (measured at 12 months). To assess LCS knowledge at baseline, we asked participants, “which of these conditions do you think that the CT scan screens for?” (Miranda et al. 2017). To assess change in LCS knowledge at 12 months, we asked participants “Has your knowledge changed regarding lung cancer screening?”. We used adjusted logistic regression to detect an association between LCS knowledge and adherence adjusting for age, race/ethnicity, reading difficulty, income, and study site. Results: A total of 201 participants were included (Table). Overall adherence rate to 12 months follow up guidelines was high at 80.1%. Adherence rates were similar in regards to age, gender, race, smoking status, employment status, income, reading difficulty and study site. Only approximately half of the participants answered the baseline knowledge question correctly (49.1% correct). Most participants (82.8% of the total) reported no change in their LCS knowledge at 12 months. Adherence rates for patients without knowledge change was 79.0% versus 86.5% for patients with knowledge change (p=0.36). After adjusting for potential confounding variables, correctly answering the primary question was not significantly associated with higher adherence to LCS at 12 months following the initial LDCT (odds ratio 1.5, 95% CI [0.61, 3.85], p=0.37). Conclusions: Our results suggest that knowledge about LCS does not influence adherence to follow-up recommendations. A core component of shared decision making is to increase patient knowledge about LCS. However, increased knowledge about LCS alone appears to be insufficient to improve adherence. This finding suggests that other strategies are necessary to address barriers to adherence for patients eligible for lung cancer screening.</jats:p> <jats:p/>