Māori perspectives on a potential low dose CT lung cancer screening programme in Aotearoa New Zealand: results of a mixed-method cross-sectional survey

Lung cancer screening reduces lung cancer mortality by at least 20%. If implemented equitably, it has the potential to reduce inequities for Māori (the Indigenous people of Aotearoa New Zealand), whose rates of lung cancer are significantly higher than non-Māori. Our aim was to inform the equitable implementation of potential future lung cancer screening in Aotearoa by understanding the acceptability, decision making processes and design preferences for Māori and their whānau. In 2020, Māori potentially eligible for lung cancer screening (n = 388) and their whānau/family members (n = 103) completed separate cross-sectional surveys about how a future screening programme could be designed and delivered. The focus of the surveys was to determine the level of support for a lung screening programme and to explore decision making and design preferences for Māori and their whānau. The two surveys were analysed separately with pre-defined responses reported as frequencies and percentages. Fisher’s exact tests were used to compare responses between gender, region, age-group and smoking status. Significant differences were further explored using pairwise comparisons with Bonferroni correction. Free text comments were analysed thematically. There was a very high level of support for a lung screening programme. When deciding whether to take part in screening, the strongest preferences were to follow doctors’ advice, followed by deciding alone, or with their whānau. An almost equal proportion of participants preferred to receive an invitation from their GP, or from a screening programme. Preferences for receiving information about the programme varied, with the most common being talking directly to a doctor, followed by reading a brochure, or receiving information via email. The results showed clear differences in preferences between demographic groups, particularly between regions and age-groups. Surveys of potentially eligible Māori participants and their whānau have revealed support for screening, but diverse preferences regarding decision making and programme design. These findings have informed a randomised controlled trial on lung cancer screening invitation approaches and will guide the development of a national lung screening programme.