Independent Predictors Associated with Patient Refusal of Invasive Diagnostic Procedures After Positive LDCT Lung...

Area of Science:

• Medical Imaging and Diagnostics
• Public Health and Epidemiology
• Oncology

Background:

• Low-dose computed tomography (LDCT) screening significantly reduces lung cancer mortality.
• Effectiveness of LDCT screening hinges on completing diagnostic procedures after positive results.
• Refusal of recommended invasive diagnostic procedures is an understudied barrier to screening effectiveness.

Purpose of the Study:

• To identify factors associated with patient refusal of invasive diagnostic procedures following positive LDCT lung cancer screening.
• To analyze demographic, clinical, smoking-related, and perceptual factors influencing this refusal.
• To assess the impact of refusal on diagnostic pathways and screening program effectiveness.

Main Methods:

• Retrospective observational study of participants in a multicenter LDCT lung cancer screening program.
• Inclusion of consecutive participants screened between September 2020 and October 2025.
• Analysis of positive LDCT findings (Lung-RADS 4A, 4B, 4X) and refusal of invasive procedures within six months.
• Multivariable logistic regression to determine independent predictors of refusal.

Main Results:

• Of 10,261 screened individuals, 4.7% had positive LDCT findings, with 12.5% refusing invasive evaluation.
• Multimorbidity, previous malignancy, higher cumulative smoking exposure, and screening center were independently associated with refusal.
• Greater personal concern about lung cancer risk correlated with lower refusal rates.
• Time to bronchoscopy varied by center and year; time to surgery was consistent.

Conclusions:

• Refusal of invasive diagnostics post-positive LDCT screening is a substantial implementation challenge.
• Patient vulnerability (multimorbidity, prior cancer) and system factors (screening center) influence refusal rates.
• Improving risk communication and optimizing diagnostic pathways can enhance screening continuity and effectiveness.