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General views on preventive care (screening)
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•“[It’s] especially like when you’re maybe 35, 40 years old, that’s when people start opening their eyes. I think that as you get older, people are more interested in, ‘yeah, let’s go check something out.’”
“Well, I think that those are great. I get a colonoscopy every five years and a mammogram every year.” “I think more people would probably participate providing they can afford it. When you mention medical to anybody, the first thing they think of is, ‘here goes the money.’” “Like my husband, he’s ‘oh, I’m superman. I don’t need to go to the doctor’s’ and I’m telling him, ‘you don’t know that, you may think everything’s fine.’”
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“I’ve done mammograms, and I think that’s a good thing for the women to do. I tell my daughter the same thing. I go, ‘you need to take care of yourself.’” “I had a . . . what do you call it? Borderline cancer of my cervix at one time. I was younger, and I went for my Pap and they told me I had an abnormal Pap.” “I really, actually I don’t like doctors. I get scared about what they’re gonna tell me, but now I’m at this age where I’m having these symptoms and these things that are happening to me. I’m more concerned about myself so I need to get help.” “No, they [family members] don’t go to the doctor as much as I do.”
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Knowledge and receptivity to LCDT screening for lung cancer
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“I’m just now learning that they use chest x-ray and CT. Thirty years ago, I’d say, ‘Ah, bullshit.’ I would usually tell somebody, thanks, but I’m not interested. But I thought about it and you know what? I’ll be generous enough to at least give you that.” “[prior to a diagnosis of breast cancer, she would have said] ‘I don’t need it.’ You know? I mean, that’s just it, you don’t really think about it. You know? Until something happens.” “I don’t think so. Oh, absolutely. Especially at my age. I think it alleviates uncertainty. And when you’re referred and scheduled for one of these, you really need to have answers. I don’t work well with uncertainties.” “There’s got to be some type of a screening for us smokers, because when I went in last year, I didn’t have the spot on my lung and if it was screened, it wouldn’t have gotten as big as it did and I didn’t have symptoms and I still don’t. But I have lung cancer. So CT screening would help, especially if you’re a smoker.”
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“Yes, I would if I can afford it. I’d rather do it because I want to know what’s wrong with my health so we can fix it.” “No [have not heard about it]. This is what I need. Bad. You know it’s one thing to have a breathing problem, but it’s one thing to know that without a referral you could get a scan and check your lungs. Uh, accuracy. Benefit of the doubt. You know straight up what’s wrong, what’s there and what’s not.” “Uh . . . for lung cancer, no . . . I can’t believe I [have heard about the test]. I’d have to think about it. I don’t know. I’d have to weigh it out. I’d have to do the do’s and don’ts and I don’t know. I have to think about it and who knows, I probably would.” “No [not heard]. No, I don’t think I want to do it. To be doing it every year and every year, it’s gonna stay on your head. Every year you can say you know, what’s gonna happen, what’s gonna happen?”
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Challenges to LDCT screening for lung cancer
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“Well I would think about the risks, depending on what it was, but I have a lot of faith in my providers, I think I have really good providers.” “The false readings. The continued tests that aren’t necessary.” “The cost ‘cause nowadays, I mean, everything’s so expensive. And if I have insurance, the insurance is gonna cover it, it’ll be easier because, I mean, the CT scan is what, about $1000? You have to have insurance, right? It’s money. And if we don’t have the money to pay for the treatment or what the case may be, you make it hard.” “Like here in New Mexico that you are living in the middle of nowhere. You have to travel 150 miles to get to the hospital. I can see that those kind of people, especially since the income rate within the state is as low as it is, especially for older people which would be the type of people that need this, and the . . . equipment, and technology that you need in order to do the low dose scans isn’t something that you can just roll out there in the middle of nowhere.”
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“If I can afford it. I wouldn’t be able to get it if I had to pay for it. I’d have some concern if I had to buy certain pills for it out of my pocket; I wouldn’t be able to afford it.” “False positives. Long screening, yeah, that’s a long time. The radiation, too ‘cause I heard a lot of bad things about radiation. The stress and the anxiety. Yeah, ‘cause I would be thinking about that all the time it’s going on and I don’t even like to go to doctor.” “That I know I won’t get no cancer from the radiation. That’s my main concern. You already explained to me that it’s light, it’s not a heavy radiation, so that’s appealing to me in a positive way as far as me doing it but, if it was like a high risk, you know, I’d be like, no. No, they [false positives] don’t bother me because I think that there’s a 50/50 chance.” “What my health is that’d be my most important. If I’m sick I want to know. The risk of how much that [radiation] would jeopardize my health, too. I mean how much radiation are they gonna give me? What is it gonna do to me, the side effects, you know? That [annual screening] wouldn’t be a problem.”
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Smoking cessation in the context of LDCT for lung cancer
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“No, and I think most people would be in that same boat. You know, they got good news [ie, lungs are fine], so it didn’t help them change nothing [ie, quit smoking]” “No, I don’t think so. I think at that point I probably would have still lit up the day before I went or the day of going to the test. I would have probably thought about it after I had gotten the CT scan and seeing what the results were. That’s just where your mind’s set at and nothing scares you until you hear that word, that big C word.” “I would most likely keep smoking until they tell me that you have to stop or this is what’s gonna happen. And if I go once a year and if it shows I’m okay, most likely I’ll be smoking. If they tell me it’s cancerous, now it’s like a rude awakening. You have to stop.” “Exactly and that’s how I would feel. That oh, that’s great. Being honest with myself, if they told me today, ‘You don’t have lung cancer,’ I wouldn’t go back and pick up the cigarettes. I went through hell to get rid of them. But people that are smoking were told, ‘No, your lungs are just fine. There’s nothing wrong with them.’ I think most people would go, ‘Whew. I thought they were going to tell me I had to quit.’”
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“I don’t know. I think when somebody wants to quit they’ve gotta just want to quit. I probably would [quit] if you showed me how bad my lungs were and what I’ll look like in 3 more years.” “Oh hell yeah, that would tell me yay or nay, throw it away. [If negative result] That means that I’m really not a problem smoker. [If positive result] Just smoke a cigarette and think about what it is, at least it’s got my attention. You know like let’s say if it wasn’t quitting smoking and it’s only getting worse, was the smoking keeping it at a minimum? I would probably sit there and give it the 6-month lap. That means I would still smoke, but a lot, lot less, so by the time the last 2 months of that 6 months come, I would be not smoking.” “[If positive result] I hope it would really sink inside me and say, ‘hey, you know what? You’ve got to quit’. [If negative result] No, I think I would want to still quit. Because I say that, ‘hey, next week, boom, I could just get it.’” “Yes. I’ll get a better understanding and a better reading about what’s on the CT scan. I’ll get more feedback from a doctor, from a professional. I think it would benefit me and help me stop smoking even more if I knew that, that there is complications that are going on.”
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Information needs and preferred communication methods
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“One-on-one, is the way that I want my information. I want my information to come directly from my doctor or from the nurse that I’m working with or the clinic I’m working with.” “Probably the percentages of . . . the false readings. The results of what happens when they get false readings. Probably printed material. Face time with doctor.” “All the information I could get . . . and in plain words, which I could probably understand it, that would be the best. Information about the test and the consequences and the procedure itself time-wise. Most people do sit down a lot and watch movies or DVDs. I think they would just like a 15 minute explanation of the procedure, how it’s done, why this is being done, what kind of machine is gonna be used. The doctor is the actual one that’s gonna give you the results.” “I think there should be a lot more, instead of the smoking cessation like the 1-800-QUIT NOW. They showed the guy with the hole in the throat, the woman with the lung removed, things like that, and then after that could be an informative little message about if you [smoke] . . . this could be prevented with a CT scan now. [A] family member should be involved or family member to come with them, ‘cause the family member will most likely talk them into it. For me I want to know from the doctor. I think pamphlets in the doctor’s office on the wall, like they have other pamphlets there, because the longer you wait, the more you get bored and the more you read.”
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“Just show me pictures of lungs. People on more medication. When I come into my appointments and I’m sitting down, that’s how I read. Sometimes people won’t come to doctors, because they just have a thing; for them I would say grocery stores, where the ads are for the Quick Quarter or the cars. Pamphlet there or something for smokers.” “All the risk and the cost, but mostly the risk. “Maybe on a DVD or something so you could watch, ‘cause sometimes a lot of people don’t like to read. Like I don’t like to really read. The doctor, too, but sometimes the doctors have certain amount of time to talk to you. Sometimes some people don’t have [time] for the Internet. They don’t have computers, I don’t have a computer.” “The correct information, the information that is stated on a piece of paper and the information that is stated from a professional. Information about the procedure, risks, benefits, future treatment, side effects. A video, you know like a video going through a facility like we’re here and you pull out a video and say, ‘look, this is what it consists of.’ It could be a trained health professional.” “I know I’ve smoked for a long time. I don’t really know what my lungs look like. If the people knew how bad their lungs were, maybe they would think about it a little more. Pretty much straight from my doctor, yeah I’d rather hear from him. Reading it and stuff really just doesn’t hit you as like the doctor telling you. You might have a question that you want to ask, and with a video you won’t be able to ask any questions.”
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