Ambreen Sayani1,2, Mandana Vahabi3,4, Mary Ann O'Brien5,6, Geoffrey Liu7,8, Stephen W Hwang9,10, Peter Selby6,7,11,12, Erika Nicholson13, Aisha Lofters9,5,4,6,7,14. 1. MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. ambreen.sayani@wchospital.ca. 2. Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada. ambreen.sayani@wchospital.ca. 3. Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada. 4. ICES, Toronto, Ontario, Canada. 5. Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada. 6. Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. 7. Dalla Lana School of Public Health, Toronto, Ontario, Canada. 8. Princess Margaret Cancer Centre, Toronto, Ontario, Canada. 9. MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. 10. Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 11. Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. 12. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. 13. Canadian Partnership Against Cancer, Toronto, Ontario, Canada. 14. Department of Family Medicine, Women's College Hospital, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Individuals living with low income are less likely to participate in lung cancer screening (LCS) with low-dose computed tomography. Family physicians (FPs) are typically responsible for referring eligible patients to LCS; therefore, we sought to understand their perspectives on access to lung cancer screening for individuals living with low income in order to improve equity in access to LCS. METHODS: A theory-informed thematic analysis was conducted using data collected from 11 semi-structured interviews with FPs recruited from three primary care sites in downtown Toronto. Data was coded using the Systems Model of Clinical Preventative Care as a framework and interpretation was guided by the synergies of oppression analytical lens. RESULTS: Four overarching themes describe FP perspectives on access to LCS for individuals living with low income: the degree of social disadvantage that influences lung cancer risk and opportunities to access care; the clinical encounter, where there is often a mismatch between the complex health needs of low income individuals and structure of health care appointments; the need for equity-oriented health care, illustrated by the neglect of structural origins of health risk and the benefits of a trauma-informed approach; and finally, the multiprong strategies that will be needed in order to improve equity in health outcomes. CONCLUSION: An equity-oriented and interdisciplinary team based approach to care will be needed in order to improve access to LCS, and attention must be given to the upstream determinants of lung cancer in order to reduce lung cancer risk.
BACKGROUND: Individuals living with low income are less likely to participate in lung cancer screening (LCS) with low-dose computed tomography. Family physicians (FPs) are typically responsible for referring eligible patients to LCS; therefore, we sought to understand their perspectives on access to lung cancer screening for individuals living with low income in order to improve equity in access to LCS. METHODS: A theory-informed thematic analysis was conducted using data collected from 11 semi-structured interviews with FPs recruited from three primary care sites in downtown Toronto. Data was coded using the Systems Model of Clinical Preventative Care as a framework and interpretation was guided by the synergies of oppression analytical lens. RESULTS: Four overarching themes describe FP perspectives on access to LCS for individuals living with low income: the degree of social disadvantage that influences lung cancer risk and opportunities to access care; the clinical encounter, where there is often a mismatch between the complex health needs of low income individuals and structure of health care appointments; the need for equity-oriented health care, illustrated by the neglect of structural origins of health risk and the benefits of a trauma-informed approach; and finally, the multiprong strategies that will be needed in order to improve equity in health outcomes. CONCLUSION: An equity-oriented and interdisciplinary team based approach to care will be needed in order to improve access to LCS, and attention must be given to the upstream determinants of lung cancer in order to reduce lung cancer risk.
Entities:
Keywords:
Family physician perspectives; Health equity; Lung-cancer screening
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