“What do I think about implementing lung cancer screening? It all depends on how.” Acceptability and feasibility of lung cancer screening in Australia: The view of key stakeholders about health system factors

Abstract

Background Lung cancer is the number one cause of cancer death worldwide. Although international trials demonstrate that targeted screening using low dose computed tomography (LDCT) significantly reduces lung cancer mortality, implementation of screening in the high-risk population presents complex health system challenges that need to be thoroughly understood to support policy change. Aim To elicit health care providers’ and policymakers’ views about the acceptability and feasibility of lung cancer screening (LCS) and barriers and enablers to implementation in the Australian setting. Methods We conducted 24 focus groups and three interviews (22 focus groups and all interviews online) in 2021 with 84 health professionals, researchers, and current cancer screening program managers and policy makers across all Australian states and territories. Focus groups included a structured presentation about lung cancer and screening and lasted approximately one hour each. A qualitative approach to analysis was used to map topics to the Consolidated Framework for Implementation Research. Results Nearly all participants considered LCS to be acceptable and feasible but identified a wide range of implementation challenges. Topics (five specific to health systems and five cross-cutting with participant factors) identified were mapped to CFIR constructs, of which ‘readiness for implementation’, ‘planning’ and ‘executing’ were most salient. Health system factor topics included delivery of the LCS program, cost, workforce considerations, quality assurance and complexity of health systems. Participants strongly advocated for streamlined referral processes. Practical strategies to address equity and access, such as using mobile screening vans, were emphasised. Conclusions Key stakeholders readily identified the complex challenges associated with the acceptability and feasibility of LCS in Australia. The barriers and facilitators across health system and cross-cutting topics were clearly elicited. These findings are highly relevant to the scoping of a national LCS program by the Australian Government and a subsequent recommendation for implementation.

“We need to work towards it, whatever it takes.”—participation factors in the acceptability and feasibility of lung cancer screening in Australia: the perspectives of key stakeholders

“…A graphic representation of the high-level topics in the coding framework is shown in Figure 1 . The full coding framework can be found elsewhere ( 32 ). Following the proposed screening and assessment pathway, the data was coded into five themes and CFIR domains are reflected throughout: (I) promotion to and recruitment of the eligible population, (II) risk assessment, (III) screening, (IV) referral and management, and (V) return for screening.…”

“…The presentation consisted of 14 PowerPoint slides in total, 8 of which posed questions to facilitate discussion. This manuscript focuses on the participation factors when implementing a LCS program, with two manuscripts focused on (I) health system factors ( 32 ) and (II) smoking cessation.…”