Advancing health equity in cancer care: The lived experiences of poverty and access to lung cancer screening.

BACKGROUND

Individuals living with low income are more likely to smoke, have a higher risk of lung cancer, and are less likely to participate in preventative healthcare (i.e., low-dose computed tomography (LDCT) for lung cancer screening), leading to equity concerns. To inform the delivery of an organized pilot lung cancer screening program in Ontario, we sought to contextualize the lived experiences of poverty and the choice to participate in lung cancer screening.

METHODS

At three Toronto academic primary-care clinics, high-risk screen-eligible patients who chose or declined LDCT screening were consented; sociodemographic data was collected. Qualitative interviews were conducted. Theoretical thematic analysis was used to organize, describe and interpret the data using the morphogenetic approach as a guiding theoretical lens.

RESULTS

Eight participants chose to undergo screening; ten did not. From interviews, we identified three themes: Pathways of disadvantage (social trajectories of events that influence lung-cancer risk and health-seeking behaviour), lung-cancer risk and early detection (upstream factors that shape smoking behaviour and lung-cancer screening choices), and safe spaces of care (care that is free of bias, conflict, criticism, or potentially threatening actions, ideas or conversations). We illuminate how 'choice' is contextual to the availability of material resources such as income and housing, and how 'choice' is influenced by having access to spaces of care that are free of judgement and personal bias.

CONCLUSION

Underserved populations will require multiprong interventions that work at the individual, system and structural level to reduce inequities in lung-cancer risk and access to healthcare services such as cancer screening.

Déclaration de conflit d'intérêts

AS is supported by a Postdoctoral Fellowship Award from the Canadian Institutes for Health Research. AL is supported by a New Investigator Award from the Canadian Institutes for Health Research, as Clinician Scientist by the Department of Family Medicine at the University of Toronto and as Chair of Implementation Science at the Peter Gilgan Centre for Women’s Cancers at Women’s College Hospital in partnership with the Canadian Cancer Society. AL is the Provincial Primary Care Lead for Cancer Screening at Ontario Health (Cancer Care Ontario). GL is supported by the Lusi Wong Early Detection of Lung Cancer Program and the Alan B. Brown Chair. GL has received funding from an unrestricted Boehringer Ingerheim grant to develop and implement electronic methods of identifying patients suitable for lung cancer screening in family physician offices. PS is a Clinician Scientist funded by Centre of Addiction and Mental Health, Department of Family and Community Medicine and the Ministry of Health and Long Term Care to direct the STOP program- An Ontario wide smoking cessation program focused on reducing inequities of access for discriminated and underrepresented populations. He also receives support from the Medical Psychiatry Alliance. He has independent grants from the GRAND program, created as an arms-length peer reviewed program for smoking cessation. He is an advisor to both Cancer Care Ontario and Canadian Partnership Against Cancer (CPAC) on tobacco cessation in patients with Cancer. EN is an employee of the CPAC, a pan-Canadian health organization, funded by Health Canada. This does not alter our adherence to PLOS ONE policies on sharing data and materials.