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Low (radiation) dose computed tomography (LDCT) screening is a promising strategy for detecting lung cancer early among those at high risk of lung cancer before they experience any symptoms. LDCT screening reduced the relative risk of death by 20% in the U.S. National Lung Screening Trial and by 24% (men only) in the Dutch-Belgian Trial ‘NELSON’. High risk is primarily defined by age (55-80 years) and a significant and recent tobacco smoking history depending upon the indices of cigarette smoking duration, heaviness and frequency, in addition to other individual risk factors such as family history of lung cancer and personal history of respiratory illness. One potential barrier to the acceptability of LDCT lung cancer screening is the relatively high frequency of abnormal results. Abnormal lung cancer screening results are common because as well as detecting lung cancer, low-dose CT scans also detect abnormalities that look like early cancers but are harmless, so-called ‘indeterminate pulmonary nodules’, which can be common in the populations targeted for lung cancer screening. In the National Lung Screening Trial, 39% of participants received at least one abnormal result, but after further scans, the majority (96%) of these were found to be harmless. In England, around 15% of individuals are projected to have indeterminate pulmonary nodules detected on their first screen, which would require surveillance for two years to monitor potential growth but are most often harmless. The proposed study aims to achieve an in-depth understanding of patients’ experiences of, and psychological responses to, being diagnosed with a pulmonary nodule through LDCT screening, undergoing surveillance, and the communication and information they receive. A diverse sample of individuals undergoing screen-detected pulmonary nodule surveillance, as well as healthcare professionals who communicate nodule diagnoses and surveillance, will be interviewed about their experience and communication practices. Addressing this evidence gap is vital to inform the development of standardised and quality-assured principles for communication standards which promote psychological well-being, improve individuals’ experience and future participation in screening, and support health care professionals in this challenging role. This research prioritises a person-centred approach to the communication and delivery of pulmonary nodule surveillance through LDCT lung cancer screening, key to optimising participant outcomes and the success of any future U.K. national programme. It aims to provide novel insight into individuals’ experiences of pulmonary nodule diagnosis and surveillance through LDCT screening, to inform the development of evidence-based communication principles and resources that promote psychological well-being, and to minimise distress and maximise future participation. It would therefore have translational findings for U.K. policy and practice of lung cancer screening services and health professionals (in collaboration with patients). |
