Understanding Patient-Level Variables That Influence Lung Cancer-Screening Behavior and the Nurse's Role

2.50
Hdl Handle:
http://hdl.handle.net/10755/621756
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Understanding Patient-Level Variables That Influence Lung Cancer-Screening Behavior and the Nurse's Role
Other Titles:
Global Influences on Cancer Screening
Author(s):
Carter-Harris, Lisa; Rawl, Susan M.
Lead Author STTI Affiliation:
Alpha
Author Details:
Lisa Carter-Harris, PhD, RN, ANP-C, Professional Experience: 1. Doria-Rose VP, White MC, Klabunde CN, et al. Use of lung cancer screening tests in the United States: results from the 2010 National Health Interview Survey. Cancer Epidemiol Biomarkers Prev. 2012;21(7):1049–1059. 2. Aberle, DR, Adams AM, Berg, CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011; 365(5): 395-409. PMID:21714641. Author Summary: Dr. Lisa Carter-Harris is a nurse scientist with over a decade of clinical experience as an adult nurse practitioner. She is currently an Assistant Professor in the School of Nursing at Indiana University and an Associate Member in the Cancer Prevention & Control Program at the IU Simon Cancer Center. She completed her PhD at the University of Louisville in nursing science followed by a 2-year postdoctoral fellowship in behavioral oncology at Indiana University.
Abstract:

Purpose: Lung cancer kills more people in the U.S. than breast, colorectal, pancreatic, and prostate cancers combined (American Cancer Society, 2016). Most die because they are diagnosed at an advanced stage with limited treatment options and a 1% five-year relative survival rate (American Cancer Society, 2016). Until recently, an effective screening test to identify lung cancer at an earlier stage did not exist. However, lung cancer screening with low-dose computed tomography is a recent U.S. Preventive Services Task Force Grade B recommendation for long-term smokers (Aberle et al., 2011; USPSTF 2014). Understanding variables that may or may not influence screening participation at the individual level is essential (Carpenter, 2010; Jonnalagadda et al., 2012). However, lung cancer screening also has potential harms which must be balanced against its benefits and may be weighed differently by different individuals. Shared decision-making is particularly important within contexts where one best solution does not exist (Makoul & Clayman, 2006). This is the case in lung cancer screening – where benefits are present, but risk and uncertainty exists and is patient specific. Nursing is uniquely poised to foster shared decision-making in lung cancer screening decisions through patient education, but we must first understand knowledge, risk perception, and health beliefs in the screening-eligible patient population in order to develop effective patient-level interventions that enhance shared decision-making in lung cancer screening, and subsequent screening behavior, in those at greatest risk. Therefore, the purposes of this study were to: (1) describe long-term smokers’ knowledge and perceptions of lung cancer, risk, and screening; and (2) examine relationships between individual health beliefs (risk, benefits, barriers, self-efficacy) and screening behavior.

Methods:  Descriptive, cross-sectional two-phase design using qualitative and quantitative data. Phase I: 4 focus groups (N=26) were recruited; 2 groups who recently completed lung cancer screening (n=12) and 2 groups who had never been screened (n=14). Data was collected via audio recordings and analyzed using thematic content analysis. Phase II: Guided by the Conceptual Model on Lung Cancer Screening Participation (Carter-Harris, Davis, & Rawl, 2016), a national convenience sample of screening-eligible individuals was recruited to collect data using survey methods (N=497). Data measured multiple variables including sociodemographic, health status characteristics and individual health beliefs.

Results: Phase I revealed low knowledge levels and confusion about risk factors and screening, and variables such as risk, benefits, barriers, self-efficacy, stigma, mistrust, fatalism, fear, and worry may be uniquely relevant in lung cancer screening. Using logistic regression in Phase II, we found perceived benefits (p<.001; OR=1.08, 95%CI (1.04, 1.14) and self-efficacy (p=.001; OR=1.06, 95%CI (1.02, 1.09) statistically significant, while perceived barriers was moderately significant (p=.054; OR=0.98, 95% CI (0.96, 1.00) with lung cancer screening behavior. Perceived benefits (p<.001) and self-efficacy (p=.019) maintained statistical significance with similar odds ratios, and barriers remained borderline significant (p=.081) when adjusted for other variables using multivariable logistic regression.

Conclusion:  Results from this study indicate individual health beliefs and other individual-level variables may be important in understanding lung cancer screening behavior in long-term smokers. Nursing is an integral component in the patient education process related to cancer screening and primary and secondary prevention. Nursing-delivered interventions tailored on salient variables and integrated into the primary care visit to support patient-provider discussions about, and decisions related to, lung cancer screening are needed to advance the science of this new screening option to support early detection of the world’s deadliest cancer.

Keywords:
cancer screening; health beliefs; patient education
Repository Posting Date:
10-Jul-2017
Date of Publication:
10-Jul-2017
Other Identifiers:
INRC17H13
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleUnderstanding Patient-Level Variables That Influence Lung Cancer-Screening Behavior and the Nurse's Roleen_US
dc.title.alternativeGlobal Influences on Cancer Screeningen
dc.contributor.authorCarter-Harris, Lisaen
dc.contributor.authorRawl, Susan M.en
dc.contributor.departmentAlphaen
dc.author.detailsLisa Carter-Harris, PhD, RN, ANP-C, Professional Experience: 1. Doria-Rose VP, White MC, Klabunde CN, et al. Use of lung cancer screening tests in the United States: results from the 2010 National Health Interview Survey. Cancer Epidemiol Biomarkers Prev. 2012;21(7):1049–1059. 2. Aberle, DR, Adams AM, Berg, CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011; 365(5): 395-409. PMID:21714641. Author Summary: Dr. Lisa Carter-Harris is a nurse scientist with over a decade of clinical experience as an adult nurse practitioner. She is currently an Assistant Professor in the School of Nursing at Indiana University and an Associate Member in the Cancer Prevention & Control Program at the IU Simon Cancer Center. She completed her PhD at the University of Louisville in nursing science followed by a 2-year postdoctoral fellowship in behavioral oncology at Indiana University.en
dc.identifier.urihttp://hdl.handle.net/10755/621756-
dc.description.abstract<p><strong>Purpose: </strong><span>Lung cancer kills more people in the U.S. than breast, colorectal, pancreatic, and prostate cancers combined (American Cancer Society, 2016). Most die because they are diagnosed at an advanced stage with limited treatment options and a 1% five-year relative survival rate (American Cancer Society, 2016). Until recently, an effective screening test to identify lung cancer at an earlier stage did not exist. However, lung cancer screening with low-dose computed tomography is a recent U.S. Preventive Services Task Force Grade B recommendation for long-term smokers (Aberle et al., 2011; USPSTF 2014). Understanding variables that may or may not influence screening participation at the individual level is essential (Carpenter, 2010; Jonnalagadda et al., 2012). However, lung cancer screening also has potential harms which must be balanced against its benefits and may be weighed differently by different individuals. Shared decision-making is particularly important within contexts where one best solution does not exist (Makoul & Clayman, 2006). This is the case in lung cancer screening – where benefits are present, but risk and uncertainty exists and is patient specific. Nursing is uniquely poised to foster shared decision-making in lung cancer screening decisions through patient education, but we must first understand knowledge, risk perception, and health beliefs in the screening-eligible patient population in order to develop effective patient-level interventions that enhance shared decision-making in lung cancer screening, and subsequent screening behavior, in those at greatest risk. Therefore, the </span><strong>purposes </strong><span>of this study were to: (1) describe long-term smokers’ knowledge and perceptions of lung cancer, risk, and screening; and (2) examine relationships between individual health beliefs (risk, benefits, barriers, self-efficacy) and screening behavior.</span></p> <p><strong>Methods: </strong><strong> </strong>Descriptive, cross-sectional two-phase design using qualitative and quantitative data. Phase I: 4 focus groups (N=26) were recruited; 2 groups who recently completed lung cancer screening (n=12) and 2 groups who had never been screened (n=14). Data was collected via audio recordings and analyzed using thematic content analysis. Phase II: Guided by the Conceptual Model on Lung Cancer Screening Participation (Carter-Harris, Davis, & Rawl, 2016), a national convenience sample of screening-eligible individuals was recruited to collect data using survey methods (<em>N</em>=497). Data measured multiple variables including sociodemographic, health status characteristics and individual health beliefs.</p> <p><strong>Results: </strong>Phase I revealed low knowledge levels and confusion about risk factors and screening, and variables such as risk, benefits, barriers, self-efficacy, stigma, mistrust, fatalism, fear, and worry may be uniquely relevant in lung cancer screening. Using logistic regression in Phase II, we found perceived benefits (<em>p</em><.001; OR=1.08, 95%CI (1.04, 1.14) and self-efficacy (<em>p</em>=.001; OR=1.06, 95%CI (1.02, 1.09) statistically significant, while perceived barriers was moderately significant (<em>p</em>=.054; OR=0.98, 95% CI (0.96, 1.00) with lung cancer screening behavior. Perceived benefits (<em>p<</em>.001) and self-efficacy (<em>p</em>=.019) maintained statistical significance with similar odds ratios, and barriers remained borderline significant (<em>p</em>=.081) when adjusted for other variables using multivariable logistic regression.</p> <p><strong>Conclusion: </strong> Results from this study indicate individual health beliefs and other individual-level variables may be important in understanding lung cancer screening behavior in long-term smokers. Nursing is an integral component in the patient education process related to cancer screening and primary and secondary prevention. Nursing-delivered interventions tailored on salient variables and integrated into the primary care visit to support patient-provider discussions about, and decisions related to, lung cancer screening are needed to advance the science of this new screening option to support early detection of the world’s deadliest cancer.</p>en
dc.subjectcancer screeningen
dc.subjecthealth beliefsen
dc.subjectpatient educationen
dc.date.available2017-07-10T18:10:24Z-
dc.date.issued2017-07-10-
dc.date.accessioned2017-07-10T18:10:24Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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