Race and Lung Cancer Surgery—A Qualitative Analysis of Relevant Beliefs and Management Preferences

Purpose/Objectives: To gain a better understanding of beliefs about the utility of lung cancer resection surgery and preferences for lung cancer management among African American and Caucasian adults.

Research Approach: Qualitative.

Setting: The Philadelphia Veterans Affairs Medical Center.

Participants: 21 participants (9 African Americans and 12 Caucasians; 11 with chronic obstructive pulmonary disease and 10 with lung cancer).

Methodologic Approach: Three focus groups were conducted. Transcripts and field notes were coded, grouped into thematic categories, and explored in later focus groups.

Main Research Variables: Beliefs about lung cancer resection surgery and management preferences.

Findings: African Americans doubted that surgery was needed, questioned its efficacy, and preferred complementary and alternative medicine (CAM). African Americans and Caucasians believed that exposure to air during surgery could cause tumor spread and were skeptical that smoking caused lung cancer. Therefore, they had a sense of treatment futility. Conversely, Caucasians were impatient with forced waiting for surgery. Both groups believed that surgery would be better accepted if current patients met past surgical patients, obtained second opinions, and had trusting patient-provider relationships.

Conclusions: Suspicion about surgeons' motives and perceived ineffectiveness of surgery, as well as support for CAM among African Americans, may contribute to key racial disparities in lung cancer care.

Interpretation: If providers understand more clearly the beliefs and preferences that impede acceptance of surgical resection, then they can formulate educational interventions directed at overcoming patient resistance. The clinical utility of such individualized interventions could be evaluated in future studies.