Purpose: Early identification of lung cancer through low-dose computed tomography screening is associated with improved outcomes. However, in countries where lung cancer screening (LCS) is currently offered, participation is generally low. This comprehensive review aimed to synthesise existing literature on factors associated with LCS participation.
Methods: PubMed, CINAHL, and PsycINFO were searched for peer-reviewed articles. A review of reviews published before 2021, and a systematic review of original research published from 2021 onward were conducted. Facilitators and barriers of LCS were 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 using the Mixed-Methods and the Joanna Briggs Institute appraisal tools.
Results: Over 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 (program promotion, 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 healthcare 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).
Conclusions: Governments 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.