Patient and Healthcare Provider Barriers in the LDCT Lung Cancer Screening Continuum

Area of Science:

• Oncology
• Public Health
• Radiology

Background:

• Annual low-dose computed tomography (LDCT) screening for lung cancer shows mortality benefits but suffers from low real-world uptake and adherence.
• Patient and provider factors significantly impede the successful implementation of lung cancer screening programs.

Purpose of the Study:

• To review patient- and provider-level factors influencing lung cancer screening participation and adherence.
• To identify strategies for enhancing equitable engagement across the screening continuum.

Main Methods:

• A systematic literature search of PubMed and Web of Science was conducted for studies from 2013 to November 2025.
• Included qualitative, quantitative studies, protocols, and reviews on LDCT screening uptake, adherence, and follow-up.
• Synthesized evidence focused on patient- and provider-level determinants of screening behavior.

Main Results:

• Patient-level barriers include limited awareness, misconceptions about asymptomatic disease, fear, fatalism, stigma, and medical mistrust, all linked to reduced screening.
• Provider-level barriers involve insufficient guideline knowledge, time constraints, and difficulties in shared decision-making, impacting referrals and follow-up.
• Both patient and provider factors substantially influence screening participation and continuity.

Conclusions:

• Lung cancer screening effectiveness necessitates a shift towards a longitudinal care model.
• Strategies to improve adherence and reduce disparities include patient navigation, enhanced provider capacity for sustained engagement, and integrated tobacco dependence treatment.