Understanding patient barriers and facilitators to uptake of lung screening using low dose computed tomography: a mixed methods scoping review of the current literature

Abstract

Background Targeted lung cancer screening is effective in reducing mortality by upwards of twenty percent. However, screening is not universally available and uptake is variable and socially patterned. Understanding screening behaviour is integral to designing a service that serves its population and promotes equitable uptake. We sought to review the literature to identify barriers and facilitators to screening to inform the development of a pilot lung screening study in Scotland. Methods We used Arksey and O’Malley’s scoping review methodology and PRISMA-ScR framework to identify relevant literature to meet the study aims. Qualitative, quantitative and mixed methods primary studies published between January 2000 and May 2021 were identified and reviewed by two reviewers for inclusion, using a list of search terms developed by the study team and adapted for chosen databases. Results Twenty-one articles met the final inclusion criteria. Articles were published between 2003 and 2021 and came from high income countries. Following data extraction and synthesis, findings were organised into four categories: Awareness of lung screening, Enthusiasm for lung screening, Barriers to lung screening, and Facilitators or ways of promoting uptake of lung screening. Awareness of lung screening was low while enthusiasm was high. Barriers to screening included fear of a cancer diagnosis, low perceived risk of lung cancer as well as practical barriers of cost, travel and time off work. Being health conscious, provider endorsement and seeking reassurance were all identified as facilitators of screening participation. Conclusions Understanding patient reported barriers and facilitators to lung screening can help inform the implementation of future lung screening pilots and national lung screening programmes.

ERS International Congress 2022: highlights from the Thoracic Oncology Assembly

“…The lack of primary care education for LCS referral guidelines [ 27 ] may have a negative impact in LCS, resulting in up to 30% of providers never ordering LDCT scans for eligible individuals [ 28 ]. Among the few providers ordering LDCT scans, 80.9% stated that they only order 1–3 per month [ 28 ].…”

Ergebnisse eines monozentrischen Gefäßscreeningprogramms in Deutschland

“…Durch die Einladung potenzieller Studienteilnehmer über Haus- und Facharztpraxen sollten möglichst zielgerichtet Menschen erreicht werden, die die Einschlusskriterien für das Screeningprogramm hinsichtlich Alter und kardiovaskulärer Risikofaktoren erfüllen. In der überwiegenden Mehrzahl der Fälle stellen Teilnehmer an Screeningprogrammen jedoch eine spezifische Selektion der eingeladenen Population dar, da die Bereitschaft zur Teilnahme an Screeningprogrammen regelhaft mit demografischen und sozioökonomischen Charakteristika sowie dem Risikoprofil der einzelnen Screeningteilnehmer assoziiert ist [ 1 , 8 ].…”

Impact of low-dose computed tomography screening on lung cancer incidence and outcomes

“…As such, current implementation of SDM may also represent a barrier to screening [31–33]. Other barriers to uptake include limited knowledge among patients, inadequate knowledge among primary care and other providers, concerns regarding the risk of false-positive results and overdiagnosis, and high rates of incidental findings [31,34 ▪ ] (Fig. 1).…”