Hispanic Adults Say Lung Cancer Screening Talks Must Be Clear, Warm and Fear-Free, Study Finds

Lung cancer kills more Hispanic men in the United States than any other cancer, yet the screening test that could catch it early is barely reaching the community that needs it most. In a national study of Medicare beneficiaries, only 0.7 percent of Hispanic enrollees underwent low-dose computed tomography screening, compared with 5.4 percent of White beneficiaries. A new qualitative study published in Cancer Causes & Control set out to understand why, by listening directly to Hispanic adults with long smoking histories about what they know, fear, and want from a lung cancer screening conversation. The results offer a strikingly concrete blueprint for how medicine could close one of its most stubborn equity gaps, and they reveal that the missing ingredient may not be medical technology at all, but the way doctors talk.

The research team, led by Evelyn Arana-Chicas of Rutgers Cancer Institute, conducted virtual focus groups with nineteen Hispanic adults aged 50 to 77, all current or former smokers with at least a 20 pack-year history, meaning they had smoked at least a pack a day for two decades. The participants, whose average age was 60.3 years and whose average smoking exposure was 30.6 pack-years, were recruited through the patient portal of a New Jersey health system. Two of the three sessions were conducted entirely in Spanish, reflecting the fact that 68.4 percent of participants primarily spoke Spanish, and most traced their origins to South America. The discussions were structured around the Cultural Appropriateness Framework, a well-established model that examines how cultural values, beliefs, and communication preferences should shape the design of health interventions, and the transcripts were analyzed using rapid qualitative analysis following the PARRQA rigor standards.

The first and perhaps most sobering theme was how little participants knew about lung cancer screening. Many reported that despite decades of smoking, no healthcare provider had ever mentioned the low-dose CT scan that can detect lung cancer at a curable stage. Several learned about screening only through their own internet research. Equally concerning, participants said that when screening was discussed, clinicians presented the benefits while omitting the potential downsides, leaving them unaware that screening can produce false positives, incidental findings, or overdiagnosis, the detection of slow-growing tumors that might never have caused harm. The technical vocabulary of screening also created confusion. One Spanish-speaking participant interpreted the phrase “until you are no longer eligible” as a veiled message about money, while an English-speaking participant asked pointedly what a five-year survival statistic actually means for an individual patient.

The second theme centered on communication style, and the participants’ preferences were unambiguous. They wanted information delivered in clear, plain language, free of jargon like “overdiagnosis” and “incidental findings,” and they wanted it delivered with warmth. “It sounds very complicated, and it needs to be something everyone can understand,” one Spanish-speaking participant said of the term incidental findings. Another warned that verbosity itself erodes confidence: “I think ‘direct’ is the best. That’s important because when they start talking too much, people start distrusting.” Others described wanting a genuine face-to-face conversation in which the clinician lays out the options and, in the words of one participant, “gives me the power to make the decision.” These preferences echo the Hispanic cultural values of personalismo and simpatía, which emphasize personal relationships, trust, respect, and positive interpersonal connection in health encounters.

The third theme exposed a delicate psychological fault line: fear. Participants worried that heavily statistical or alarmist risk messaging could trigger anxiety and fatalism, the belief that a cancer diagnosis is a death sentence regardless of action. One English-speaking participant captured the translation problem of risk framing vividly: “In my [Latin American] country, you tell somebody they got a 90 percent chance of living, they’re hearing 10 percent chance of dying.” Fear of hearing a cancer diagnosis emerged as a genuine barrier that could keep people away from screening altogether, yet several participants also articulated the counterargument themselves, noting that early detection found in time is precisely what makes the frightening scan worthwhile. The participants favored balanced communication that acknowledged risks honestly while emphasizing prevention, reassurance, and the power of acting early, and they reacted negatively to language perceived as judgmental, coercive, or directive about their smoking.

The fourth theme surprised even seasoned health communication researchers: visual design matters enormously. Participants preferred bright, vibrant colors such as red and green in educational materials, and they wanted to see people who looked like them, Hispanic patients, families, and healthcare professionals, in the imagery. “We really like color. Color is we are very colorful,” one Spanish-speaking participant explained. Another was blunt about the alienating effect of generic materials: “The people in the pictures don’t look Hispanic. To me, they don’t represent us. I would identify more if I saw people who look like us.” Participants also preferred realistic photographs over cartoons or abstract graphics, viewing them as more credible for a topic as serious as cancer. These so-called peripheral elements, often treated as cosmetic afterthoughts in intervention design, functioned instead as signals that the information was truly meant for the community receiving it.

The context for this work is a stark and quantified disparity. Low-dose CT screening, validated by the National Lung Screening Trial as reducing lung cancer mortality compared with chest radiography, is recommended annually by the US Preventive Services Task Force for high-risk adults. But only about one in four eligible Americans is up to date with screening, with state-level rates ranging from 13 to 38 percent, and Hispanic adults fall disproportionately on the losing end. Under the 2021 criteria, 28.5 percent of Hispanic adults are screening-eligible compared with 35.8 percent of non-Hispanic White adults, partly because Hispanic adults who smoke tend to accumulate fewer pack-years. Even among those who qualify, uptake trails significantly. Hispanic individuals also face documented barriers including language obstacles, smoking-related stigma, cancer fatalism, mistrust of the healthcare system, and limited access to care.

What makes the study more than a catalog of barriers is its intended target: the TELESCOPE intervention, a telehealth program that pairs shared decision-making coaching with patient navigation to guide eligible patients through screening conversations in primary care. Because Medicare requires a shared decision-making visit before reimbursing a first screening scan, the quality of that conversation is not a nicety but a structural gatekeeper. The new findings give the Rutgers team a specific adaptation roadmap, extending beyond simple translation to communication tone, risk framing, and visual identity, while preserving the core evidence-based components of coaching and navigation. The framework analysis also showed that the themes did not map neatly onto single domains; limited awareness cut across everything, and communication preferences intersected the linguistic, evidential, and sociocultural dimensions simultaneously, suggesting that piecemeal adaptation will not be enough.

The researchers acknowledge limitations: the participants came from a single New Jersey academic center, were recruited through electronic health records and a digital portal, and met virtually, all of which may underrepresent people least connected to healthcare or technology. Group audio recordings also made it hard to attribute individual quotations reliably. Yet the diversity of national origins, language preferences, and acculturation levels among the nineteen participants lends the findings real breadth. The broader lesson radiates well beyond lung cancer. As screening programs across medicine confront populations they have historically underserved, this study argues that trust is built not only by what medicine says but by how it says it, in the vocabulary patients use, in images that reflect their faces, in a tone that respects their fears without exploiting them, and in the quiet dignity of being given a real choice.

Subject of Research: Cultural adaptation of lung cancer screening shared decision-making and navigation for Hispanic adults

Article Title: Informing the cultural adaptation of a lung cancer screening shared decision-making and navigation intervention for Hispanic adults: a qualitative study

Article References: Informing the cultural adaptation of a lung cancer screening shared decision-making and navigation intervention for Hispanic adults: a qualitative study. (n.d.). https://doi.org/10.1007/s10552-026-02257-7

Image Credits: AI Generated

DOI: 10.1007/s10552-026-02257-7

Keywords: lung cancer screening, Hispanic health, shared decision-making, cultural adaptation, health disparities, low-dose CT, patient navigation, telehealth, cancer fatalism, qualitative research, health communication, TELESCOPE intervention