Did psychosocial status, sociodemographics and smoking status affect non-attendance in control participants in the Danish Lung Cancer Screening Trial? A nested observational study

BMJ Open. 2020 Feb 20;10(2):e030871. doi: 10.1136/bmjopen-2019-030871.


Objectives: We investigated if psychosocial status, sociodemographics and smoking status affected non-attendance in the control group in the randomised Danish Lung Cancer Screening Trial (DLCST).

Design and setting: This study was an observational study nested in the DLCST. Due to large non-attendance in the control group in the second screening round we made an additional effort to collect questionnaire data from non-attenders in this group in the third screening round. We used a condition-specific questionnaire to assess psychosocial status. We analysed the differences in psychosocial status in the third and preceding rounds between non-attenders and attenders in the control group in multivariable linear regression models adjusted for sociodemographics and smoking status reported at baseline. Differences in sociodemographics and smoking status were analysed with χ2 tests (categorical variables) and t-tests (continuous variables).

Primary outcome measure: Primary outcome was psychosocial status.

Participants: All control persons participating in the third screening round in the DLCST were included.

Results: Non-attenders in the third round had significantly worse psychosocial status than attenders in the scales: 'behaviour' 0.77 (99% CI 0.18 to 1.36), 'self-blame' 0.59 (99% CI 0.14 to 1.04), 'focus on airway symptoms' 0.22 (99% CI 0.08 to 0.36), 'stigmatisation' 0.51 (99% CI 0.16 to 0.86), 'introvert' 0.56 (99% CI 0.23 to 0.89) and 'harms of smoking' 0.35 (99% CI 0.11 to 0.59). Moreover, non-attenders had worse scores than attendees in the preceding screening rounds. Non-attenders also reported worse sociodemographics at baseline.

Conclusions: Non-attenders had a significantly worse psychosocial status and worse sociodemographics compared with attenders. The results of our study contribute with evidence of non-response and attrition driven by psychosocial status, which in turn may be influenced by the screening intervention itself. This can be used to adjust cancer screening trial results for bias due to differential non-attendance.

Trial registration number: Clinicaltrials.gov Protocol Registration System (NCT00496977).

Keywords: bias; lung neoplasms; mass screening; patient dropout.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Control Groups
  • Denmark
  • Early Detection of Cancer* / adverse effects
  • Early Detection of Cancer* / methods
  • Early Detection of Cancer* / psychology
  • Female
  • Humans
  • Lung Neoplasms* / diagnosis
  • Lung Neoplasms* / prevention & control
  • Male
  • Middle Aged
  • No-Show Patients* / psychology
  • No-Show Patients* / statistics & numerical data
  • Observer Variation
  • Patient Participation / statistics & numerical data
  • Psychology*
  • Smoking Cessation / methods
  • Smoking Cessation / psychology
  • Smoking* / epidemiology
  • Smoking* / psychology
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • Tomography, X-Ray Computed / methods

Associated data

  • ClinicalTrials.gov/NCT00496977