Facilitators and barriers of lung cancer screening participation: umbrella and systematic review of the global evidence.

introductionLung cancer is the leading cancer worldwide, accounting for 2.5 million new cases and 1.8 million deaths in 2022. Early identification of lung cancer through low-dose computed tomography screening is associated with improved outcomes. However, in areas where lung cancer screening (LCS) is currently offered, participation is generally low. LCS is expanding worldwide and is a rapidly evolving field. This comprehensive review aimed to synthesise existing literature on factors associated with LCS participation.

methodsPubMed, CINAHL, and PsycINFO were searched for peer-reviewed articles. Systematic reviews published before 2021 were reviewed and synthesised, while a top-up systematic review of original research published from 2021 onward was conducted. Data on facilitators and barriers of LCS were extracted and analysed using the socio-ecological model and synthesised as an umbrella review of review articles and a systematic review of original research papers. Study quality was assessed by two independent reviewers using the Mixed Methods Appraisal Tool and the Joanna Briggs Institute appraisal tools.

resultsOver 110 million participants (N = 110,999,150) were included in seven reviews and 54 recent articles. Facilitators of LCS participation were at the organisational level (promotion of the program, trained staff, integration of LCS with other services, and supportive technology), healthcare provider level (information provision, clear screening recommendations, and positive patient relationships), and individual-level (experience with health services and awareness of cancer). Barriers were at the organisational level (reduced access, limited health insurance and inadequate workforce, communication, information resources, and technology to support the program), healthcare provider level (limited LCS skills and/or knowledge and training, sub-optimal referral processes, and insufficient awareness of health insurance coverage for screening costs ), and individual-level (low awareness of LCS and its cost coverage by health insurance, fear of being diagnosed with cancer, time constraints).

conclusionsGovernments and healthcare services providing LCS programs may maximise facilitators and address barriers to LCS participation by working collaboratively with other stakeholders (e.g., health insurance companies, technology specialists, researchers). A focus on upstream factors (organisation and healthcare provider levels) that drive systemic inequalities in LCS participation may have the most public health benefit.