Patient Perspectives on Health Seeking Behavior: Understanding Lived Experiences of Poverty and Lung Cancer Screening

In Canada, lung cancer is one of the most commonly diagnosed cancers and is responsible for a quarter of all cancer-related deaths. The use of low-dose CT (LDCT) to detect early-stage lung cancers that are amenable to treatment is a recent health innovation that can potentially lower mortality due to lung cancer. Screening with LDCT is currently being piloted as a provincially run program by Cancer Care Ontario. There are, however, health equity concerns for people living with low income. On one hand, they are more likely to smoke and have a higher risk of lung cancer. On the other hand, they are less likely to participate in preventative healthcare such as cancer screening. Using a theoretical thematic analysis informed by the morphogenetic approach, this study sought to contextualize the lived experiences of poverty and the choice to participate in cancer screening for individuals identified at high-risk of developing lung cancer. By placing lay knowledge of those with lived experiences as the pivot of my analyses, I demonstrate how living and working conditions shape a trajectory of social disadvantage over the life course which underpins lifestyle choices such as smoking and an elevated health risk of developing lung cancer, as well as the need and ability to seek care. Three themes: pathways of disadvantage, lung cancer risk and early detection, and safe spaces of care 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. My findings have practical implications for the implementation of a provincially run lung cancer screening program to minimize inequities in lung cancer through cancer screening.