Engaging At-Risk Rural Residents in Secondary Lung Cancer Prevention.

Document Type


Publication Date



Rural health, population health, prevention, screening, underserved communities, cancer, smoking, focus groups, Maine

Publication Title

J Prim Care Community Health


INTRODUCTION: Rural residents are at elevated risk for lung cancer and related mortality, yet limited research has explored their perspectives on cancer risk or prevention options, including tobacco treatment and lung cancer screening with low-dose computed tomography (LDCT). This qualitative study examined attitudes and beliefs among rural adults who reported either current or former tobacco use, as well as disengagement from the health care system.

METHODS: We conducted 6 focus groups with rural Maine residents at risk for lung cancer based on age and smoking history (n = 50). Semistructured interviews explored participants' knowledge, perceptions, and attitudes regarding lung cancer risk, LDCT screening, and patient provider relationships. Inductive qualitative analysis of interview transcripts was conducted to identify key themes.

RESULTS: Participants were cognizant of their elevated lung cancer risk, yet few were aware of LDCT screening. When informed about LDCT, most participants indicated a willingness to undergo screening, although a substantial minority indicated reluctance related to fear and fatalism. Participants generally expressed the belief that relationships with a primary care provider could support their health and identified several provider factors that influence these relationships, including attention and time for patient concerns; respect and non-judgmental, nonstigmatizing attitudes; treating patients as individuals; and provider empathy and emotional support.

CONCLUSIONS: Rural residents at risk for lung cancer report limited knowledge and substantial ambivalence regarding LDCT screening, but identify provider behaviors that may promote patient-provider relationships and greater engagement with their health. More research is needed to confirm these findings and understand how to help rural residents and healthcare providers work together to reduce lung cancer risk. [Journal Abstract]


Corresponding author Erika Ziller, PhD, Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, PO Box 9300, 409 Wishcamper, Portland, ME 04104-9300, USA. Email: erika.ziller@maine.edu

Financial support for this study was provided by the Maine Lung Cancer Coalition, an initiative jointly supported by the Bristol Myers Squibb Foundation, Maine Cancer Foundation, and Maine Economic Improvement Fund.

Funding Organization

Main Lung Cancer Coalition: Bristol-Myers Squibb Foundation, Maine Cancer Foundation, Maine Economic Improvement Fund