Barriers and facilitators to uptake of lung cancer screening: A mixed methods systematic review

Yuan, Lin; Yu, Hong; Lin, Xiu Jing; Lin, Jia ling; Xiao, Hu; Huang, Fang

doi:10.1016/j.lungcan.2022.07.022

Cited by 8 publications

(14 citation statements)

References 68 publications

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“…Being a smoker can affect the execution of shared decision-making due to perceived stigma, lung cancer fatalism, and heightened levels of worry and fear of contracting lung cancer [ 35 ]. Additionally, concerns about potential risks associated with LDCT serve as a barrier to the shared decision-making process with health care providers [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Improvements in LDCT screening rates for high-risk groups have been modest. The intricate balance between the advantages and risks of LDCT impedes the utilization of lung cancer screening (LCS) [ 9 ]. Notably, compared to their non-screened counterparts, high-risk individuals who underwent LDCT had a remarkable 24% decrease in lung cancer mortality [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Exploring shared decision-making needs in lung cancer screening among high-risk groups and health care providers in China: a qualitative study

Lin,

Wang,

et al. 2024

BMC Cancer

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Background The intricate balance between the advantages and risks of low-dose computed tomography (LDCT) impedes the utilization of lung cancer screening (LCS). Guiding shared decision-making (SDM) for well-informed choices regarding LCS is pivotal. There has been a notable increase in research related to SDM. However, these studies possess limitations. For example, they may ignore the identification of decision support and needs from the perspective of health care providers and high-risk groups. Additionally, these studies have not adequately addressed the complete SDM process, including pre-decisional needs, the decision-making process, and post-decision experiences. Furthermore, the East-West divide of SDM has been largely ignored. This study aimed to explore the decisional needs and support for shared decision-making for LCS among health care providers and high-risk groups in China. Methods Informed by the Ottawa Decision-Support Framework, we conducted qualitative, face-to-face in-depth interviews to explore shared decision-making among 30 lung cancer high-risk individuals and 9 health care providers. Content analysis was used for data analysis. Results We identified 4 decisional needs that impair shared decision-making: (1) LCS knowledge deficit; (2) inadequate supportive resources; (3) shared decision-making conceptual bias; and (4) delicate doctor-patient bonds. We identified 3 decision supports: (1) providing information throughout the LCS process; (2) providing shared decision-making decision coaching; and (3) providing decision tools. Conclusions This study offers valuable insights into the decisional needs and support required to undergo LCS among high-risk individuals and perspectives from health care providers. Future studies should aim to design interventions that enhance the quality of shared decision-making by offering LCS information, decision tools for LCS, and decision coaching for shared decision-making (e.g., through community nurses). Simultaneously, it is crucial to assess individuals’ needs for effective deliberation to prevent conflicts and regrets after arriving at a decision.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Exploring shared decision-making needs in lung cancer screening among high-risk groups and health care providers in China: a qualitative study

Lin,

Wang,

et al. 2024

BMC Cancer

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“…Challenges to the necessity, legitimacy and utility of AF screening were integral to interviewees' choice not to participate, despite their broad support for screening. These were voiced through their framing of, and concerns about the practical tasks of participating, including misunderstanding instructions, travel problems, being too busy (including caring for others), health problems, bad timing, anxiety and, more rarely, the implications of the ‘spiral’ of treatment for a positive result: issues well‐recognised in the literature (e.g., Hope et al; Lin et al; McCaffery et al; McCoyd; Reid et al; Young et al) 35,43–47 …”

Section: Discussionmentioning

confidence: 99%

“…Because if I had atrial fibrillation then it's got to be treated. Then you are in a spot…oh this sounds so 35,[43][44][45][46][47] In opposition to prevalent depictions of nonscreeners as at fault in some manner, interviewees showed considerable consideration in their choice not to participate, comprehensively reviewing the screening from test through to the result, as others have found. 48 Interviewees made a detailed assessment of their risk of having AF, interpreting accepted preventative medicine messaging through the prism of their own lives (cf., Davison et al 1991), 49 replicating the decisions of nonscreeners elsewhere (e.g., Aasbø et al; Nielsen et al).…”

Section: Box 2 Summary Of Interview Topic Guidementioning

confidence: 96%

Why do people choose not to take part in screening? Qualitative interview study of atrial fibrillation screening nonparticipation

Hoare

Thomas

Powell

et al. 2023

Health Expectations

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IntroductionWhile screening uptake is variable, many individuals feel they ‘ought’ to participate in screening programmes to aid the detection of conditions amenable to early treatment. Those not taking part in screening are often presented as either hindered by practical or social barriers or personally at fault. Why some people choose not to participate receives less consideration.MethodsWe explored screening nonparticipation by examining the accounts of participants who chose not to participate in screening offered by a national research trial of atrial fibrillation (AF) screening in England (SAFER: Screening for Atrial Fibrillation with ECG to Reduce stroke). AF is a heart arrhythmia that increases in prevalence with age and increases the risk of stroke. Systematic screening for AF is not a nationally adopted programme within the United Kingdom; it provides a unique opportunity to explore screening nonparticipation outside of the norms and values attached to existing population‐based screening programmes. We interviewed people aged over 65 (n = 50) who declined an invitation from SAFER and analysed their accounts thematically.ResultsBeyond practical reasons for nonparticipation, interviewees challenged the utility of identifying and managing AF earlier. Many questioned the benefits of screening at their age. The trial's presentation of the screening as research made it feel voluntary—something they could legitimately decline.ConclusionNonparticipants were not resistant to engaging in health‐promoting behaviours, uninformed about screening or unsupportive of its potential benefits. Instead, their consideration of the perceived necessity, legitimacy and utility of this screening shaped their decision not to take part.Patient or Public ContributionThe SAFER programme is guided by four patient and carer representatives. The representatives are embedded within the team (e.g., one is a co‐applicant, another sits on the programme steering committee) and by participating in regular meetings advise on all aspects of the design, management and delivery of the programme, including engaging with interpreting and disseminating the findings. For the qualitative workstream, we established a supplementary patient and public involvement group with whom we regularly consult about research design questions.

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“…An interview guide was developed based on the literature describing lung cancer screening in clinical practice settings (Kota et al, 2022 ; Lin et al, 2022 ; Rodríguez- Rabassa et al, 2020). The guide covered awareness and knowledge of lung cancer screening, practice behaviors, patient barriers to screening, and recommendations for increasing screening.…”

Section: Methodsmentioning

confidence: 99%

Examination of provider knowledge, attitudes, and behaviors associated with lung cancer screening among Black men receiving care at a federally qualified health center

Matthews,

Inwanna,

Oyaluade

et al. 2023

Qual Res Med Healthc

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The study's goal was to look at providers' knowledge, attitudes, and behaviors regarding lung cancer screening among Black male smokers served by a federally qualified healthcare center. Participants in the study were interviewed in depth. Participants completed a short (5-10 minute) survey that assessed demographics, training, and attitudes toward lung cancer screening. For quantitative data, descriptive statistics were used, and for qualitative data, deductive thematic analysis was used. This study included ten healthcare professionals, the majority of whom identified as Black (80%) and were trained as advanced practice providers (60%). The majority of providers (90%) have heard of LDCT lung cancer screening; however, participants reported only being “somewhat” familiar with the LDCT eligibility criteria (70%). Despite generally positive attitudes toward LDCT, patient referral rates for screening were low. Barriers included a lack of provider knowledge about screening eligibility, a lack of use of shared decision-making tools, and patient concerns about screening risks. The reasons for the low referral rates varied, but they included a preference to refer patients for smoking cessation rather than screening, low screening completion and follow-up rates among referred patients, and a lower likelihood that Black smokers will meet pack-year requirements for screening. Additionally, providers discussed patient-level factors such as a lack of information, mistrust, and transportation. The study findings add to the body of knowledge about lung cancer knowledge and screening practices among providers in FQHC settings. This data can be used to create health promotion interventions aimed at smoking cessation and lung cancer screening in Black males and other high-risk smokers.

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Barriers and facilitators to uptake of lung cancer screening: A mixed methods systematic review

Cited by 8 publications

References 68 publications

Exploring shared decision-making needs in lung cancer screening among high-risk groups and health care providers in China: a qualitative study

Exploring shared decision-making needs in lung cancer screening among high-risk groups and health care providers in China: a qualitative study

Why do people choose not to take part in screening? Qualitative interview study of atrial fibrillation screening nonparticipation

Examination of provider knowledge, attitudes, and behaviors associated with lung cancer screening among Black men receiving care at a federally qualified health center

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