D22-10 The Relationship of Lung Cancer Screening Beliefs on Lung Cancer Screening Referral in Primary Care

Background Lung cancer screening (LCS) reduces mortality from the leading cause of cancer death in the United States. Patients’ beliefs about lung cancer and screening may vary by their race and ethnicity and may also influence whether primary care providers (PCPs) refer them for screening. Few studies have linked patient health beliefs directly to PCP referral behavior. Methods We recruited 221 primary care patients eligible for LCS and their PCPs (N = 119) between July 2022 and November 2025 at a Mid-Atlantic academic medical center as a part of an observational study on LCS. Patients completed sociodemographic and smoking history questionnaires before their appointment. Four dimensions of the Lung Cancer Screening Health Belief Scale (LCSHB) - perceived risk, benefits, barriers, and self-efficacy - were assessed. PCPs completed sociodemographic and practice questionnaires. After each appointment, patients reported whether their PCP referred them for LCS. To examine associations between race/ethnicity and LCSHB scores, we used a mixed effect linear regression controlling for patient and PCP characteristics. Logistic regression with generalized estimating equations assessed associations between LCSHB scores and LCS referral. Results Participants have a mean age of 64 years (SD = 7.5 years); 53.8% were women, 33.9% Hispanic, 35.7% non-Hispanic Black, and 5.0% as other. After adjustment, Black participants scored 0.96 points lower (95% CI: 1.79, 0.14, p = 0.02) on the Perceived Risk subscale and 1.52 points higher (95% CI: 0.49 - 2.54, p = 0.004) on the Perceived Benefit subscale than White participants. Each one point increase on the Perceived Barriers subscale was associated with a 16% lower odds of referral (95% CI: 4% - 27%; p = 0.01), whereas each one point increase on the Perceived Self-Efficacy subscale was associated with a 37% higher odds of referral (95% CI: 12% - 67%; p = 0.002) Conclusion Black participants perceived lower personal risk but greater benefits from screening than White participants. Higher perceived barriers and lower self-efficacy were associated with reduced likelihood of LCS referral. Addressing modifiable beliefs, particularly perceived barriers and self-efficacy may enhance equitable referral and screening uptake. Future research will examine how patient-provider communication shapes these belief-referral relationships.