Patient acceptability and preferences for communication of coronary artery calcification findings in the NHS targeted lung health checks: a qualitative study.
Patients initially reported understanding their coronary artery calcification findings but deeper exploration revealed misconceptions about personal cardiovascular disease risk, with lack of trust in doctors and reliance on non-clinical information sources acting as barriers to lipid-lowering therapy uptake.
Key Findings
Results
Patients reported surface-level understanding of CAC findings that masked deeper misconceptions about personal cardiovascular disease risk.
Ten adults aged 59-71 years with CAC detected on TLHC CT scans and a calculated QRISK >10% were interviewed
Patients initially reported understanding their findings, but deeper exploration through semi-structured interviews revealed misconceptions
Misconceptions specifically related to personal cardiovascular disease risk rather than general knowledge of the condition
The gap between reported and actual understanding was identified through thematic analysis of qualitative interview data
Results
Lack of trust in doctors was identified as a barrier to lipid-lowering therapy (LLT) uptake among patients with incidental CAC findings.
Distrust of medical professionals was identified as a recurring theme across participant interviews
Trust in the specific medical professional giving the advice also shaped acceptance of LLT
The finding suggests that the doctor-patient relationship quality influences whether patients engage with preventive cardiovascular treatment
This barrier was identified alongside reliance on non-clinical information sources as co-occurring obstacles to LLT engagement
Results
Reliance on non-clinical information sources, including social media, family, and friends, acted as a barrier to lipid-lowering therapy uptake.
Participants reported turning to social media, family, and friends for health information about their CAC findings
These non-clinical sources were identified as influencing patients' decisions regarding LLT
This reliance on informal information channels competed with clinical guidance provided by healthcare professionals
The finding was identified through thematic analysis of semi-structured interviews conducted at one general practice in North-East England
Methods
The study was conducted in an area of high social deprivation, with participants drawn from one general practice in North-East England participating in the NHS TLHC programme.
The single-site qualitative study involved ten adults aged 59-71 years
All participants had CAC detected on TLHC CT scans and a calculated QRISK >10%
The geographic setting of high social deprivation may influence generalizability of findings
Semi-structured interviews and thematic analysis were the primary research methods used
Discussion
Personalised follow-up, clearer risk explanations, enhanced patient education, and tailored communication strategies were identified as potential approaches to improve LLT uptake.
Enhancing patient education on CAC findings was recommended as a strategy to improve engagement
Fostering doctor-patient trust was identified as a key mechanism for increasing LLT acceptance
Tailoring communication strategies to individual patients was recommended
Personalised follow-up and clearer risk explanations were specifically identified as ways to reduce hesitancy and improve engagement with preventive care
Results
Patient preferences for receiving and discussing CAC results included considerations around preferred communication methods, terminology, and the role of the clinician in shaping preventive treatment decisions.
The study specifically aimed to identify patient preferences for communication of CAC results
Preferred communication methods, terminology choices, and clinician role were all explored as dimensions of patient preference
The role of the clinician in shaping preventive treatment decisions was found to be relevant to patient acceptance of LLT
These preferences were elicited through semi-structured interviews with ten participants who had confirmed CAC findings
What This Means
This research examined how people react when they are told, during a routine NHS lung cancer screening scan, that they have a buildup of calcium in the arteries of their heart — a finding called coronary artery calcification (CAC), which indicates cardiovascular disease risk. Researchers in North-East England interviewed ten people aged 59 to 71 who had received this type of incidental finding and were considered at elevated heart disease risk. Although participants initially said they understood what they had been told, more in-depth conversation revealed they had significant misunderstandings about what the finding meant for their own personal risk of heart attack or stroke.
The study found that two main factors made people reluctant to take cholesterol-lowering medication (lipid-lowering therapy) recommended to reduce their heart disease risk: distrust of doctors, and reliance on informal sources of health information such as social media, family members, and friends. Importantly, whether a person trusted the specific doctor giving them the advice also played a role in whether they were willing to take the medication. The setting — an area of high social deprivation in North-East England — may have contributed to these patterns of distrust and reliance on non-medical information.
This research suggests that simply telling patients about CAC findings is not enough to get them to engage with heart disease prevention. Healthcare providers may need to invest in building trust with patients, use clearer and more personalised explanations of what risk findings mean, and follow up in tailored ways that account for individual concerns and information habits. Better communication strategies around these incidental findings could help more people take up effective preventive treatments before serious heart events occur.
Fletcher A, Bagnall A, Graham Y. (2026). Patient acceptability and preferences for communication of coronary artery calcification findings in the NHS targeted lung health checks: a qualitative study.. BMJ open. https://doi.org/10.1136/bmjopen-2025-115544