Hard to reach groups in lung screening: Recommendations for the UK Lung Cancer Screening (UKLS) trial


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Kate Lifford1, Jana Witt1, Stephen Duffy2, David Weller3, Chris Hands4, David Baldwin5, John Field4, Kate Brain1
1Cardiff University, Cardiff, UK, 2Queen Mary University of London, London, UK, 3University of Edinburgh, Edinburgh, UK, 4University of Liverpool, Liverpool, UK, 5Nottingham University, Nottingham, UK

Background

The UK Lung Cancer Screening (UKLS) trial aims to determine whether CT scans can aid in the early detection of lung cancer and result in an overall survival benefit for those who are diagnosed with lung cancer through screening in a higher-risk population (Baldwin et al., 2011). Uptake from the general population at the initial pilot stage of this trial is important so that those who are at high risk can be identified and invited to participate further in the trial.

Method

Of 53384 people invited to take part in UKLS, by the end of December 2011 5590 (10%) had declined and completed a brief non-participation questionnaire and 13605 (25%) had completed a screening questionnaire to assess their lung cancer risk (the remaining 65% were non-responders). Demographic information and experience of lung cancer (close friend or family member) were assessed in both questionnaires. The non-participation questionnaire also included a free text box to capture reasons for not wishing to participate. Comparisons were drawn between the two groups.

Results

People who completed the non-participation questionnaire were significantly more likely to be female (57.8% non-participants, 50.1% participants, p<.001), of older age (27.2% non-participants 71+ years, 14.5% participants 71+ years, p<.001), and to have experience of lung cancer (21.1% non-participants, 18.3% participants, p<.001) compared with participants. Reasons for not wishing to take part included practical barriers, comorbidities and lack of concern about lung cancer.

Conclusion

A number of barriers, both practical and emotional, may deter individuals from participating in the UKLS trial. Tailoring the invitation materials to those who are less likely to participate will be important for future screening studies and programmes which use a multi-stage recruitment process. This will be particularly important if those participants who do not take part are potentially those at greater risk.