Table 1.

Categories generated from key informant interviews (n = 9)

Positive factors	Category	Example	Decisional values item
Early detection Being able to treat it Extend life Better survivorship	Mortality Benefit	“Obviously that it’s a screening test in kind of the whole early detection leads to earlier diagnosis and treatment and better survivorship, and all of those things are important” [Provider]	…lowering your risk of dying from lung cancer? Or …getting a lung cancer screening test that may help you live longer?
Being proactive Wanting to know Concern for cancer	Psychological effects (Positive)	“I’d want access to it and to be able to be in a proactive stance” [Individual]	…getting peace of mind to find out you do not have lung cancer? …making you feel like you are doing everything you can for your health?
Doctor recommendation Trust in doctor	Interpersonal relationships	“I think African Americans in particular, if they trust somebody, and if that somebody says they have lung cancer screening, you are more likely to do it than if somebody random does” [Provider]	…following your doctor’s opinion about lung cancer screening? …thinking about family or friends who have dealt with lung cancer?
Family history/personal experience with cancer		…So I think if I knew if you get early, and I think I do know that just by reading and different people in my life that I’ve known, you can be cured…especially if I had a history of lung cancer in my family” [Individual]
Non-invasiveness of test	Test itself	“I think positive things are knowing that it’s a noninvasive test, is really important” [Provider]	…knowing the test has little risk?
Negative factors	Category	Example	Decisional Values Item
Covered by insurance Cost Access Additional follow-up tests Overwhelmed by tests	Burden of test itself	“Well number one, I’m not sure if this test is covered by my insurance, health insurance.” [Individual]	…the out of pocket cost of the screening? …where you have to go (testing location) to get lung cancer screening? …the idea that lung cancer screening may lead to more testing if there is an abnormal result?
Age/life expectancy Other medical issues that need to be addressed	Hierarchy of life priorities	“Unfortunately once you reach a certain age, okay, you start thinking about life. And I say life instead of death” [Individual] “…do not know that screening becomes the number one priority when someone else has other medical issues to address” [Provider]	…the idea that you would prefer to focus on other things in your life than thinking about screening for lung cancer?
Do not want to know results Cannot change it Fear of death due to cancer Fear of finding something Fear cancer will spread Fear of undergoing procedures Scared of results Concerns about findings Finding some other major medical problem Not picking something up that may be there	Fear/fatalism	“They do not really want to know” [Provider] “The negative things. I do not want to know, and then I think I’m at this stage, losing my mother and everything. I do not think I could handle one more thing” [Individual]	…the idea that lung cancer screening will make you worry about lung cancer?
Limitations of screening	Limitations screening	Note: This was based upon the limitations of the test	…the idea that lung cancer screening will not find all lung cancers or all lung cancers early? …the idea that not all patients who have lung cancer diagnosed by screening will avoid death from lung cancer? …the idea that the lung cancer screening test might show something wrong that turns out not to be cancer?
Stigma of lung cancer Guilt of smoking Ashamed	Stigma	“There is a lot of baggage that comes with lung cancer screening. For smokers, that is the guilt and the shame and the nihilism on their part and on the healthcare system’s part.” [Provider]	…the idea that getting screened for lung cancer would make you feel badly about your smoking history? …the feeling that if you had lung cancer you would feel like it was your fault?
Invasiveness	Test itself	“It’s still very difficult to convince people that the benefit is worth it relative to the other cancers because I think also the invasiveness of proving it is more risky than say, mammograms and finding something abnormal on a mammogram” [Provider]	…knowing the test has little risk?