Recruitment strategies and outcomes in lung cancer screening programmes: a scoping review

Identification and recruitment of people at risk represents a crucial step in implementing large-scale lung cancer screening (LCS) programs.

We systematically reviewed the evidence to identify the best recruitment strategies, in terms of identification, outreach, and invitation of the population at risk to low-dose computed tomography (LDCT)-based lung cancer screening programs. The secondary aim was to quantify and compare their performance in terms of test coverage of the target population.

A nested systematic review was conducted searching in Medline (PubMed version), Embase, CINAHL (Ebsco version), Scopus, Cochrane CENTRAL, Clinicaltrial.gov and WHO register for studies published from January 2000 to March 2023. The main recruitment and risk assessment patterns were identified, and recruitment outcomes were calculated (e.g., test coverage, risk assessment rate, and participation rate).

Of 6075 identified references, 79 studies that describe 56 LCS programs were included in the analysis. Screening coverage ranged from 4.8% in the 'volunteers' pattern and 6.7% in the referral-based pattern to 35-40% in the population-based LCS programs. Participation rates were quite low in targeted programs (8.4-55.9%) despite high risk assessment rates, and it was variable in referral-based programs (30.9-92.5%). Participation rates in underserved populations ranged from 31% to 92% and depended on the interventions implemented to reach and retain them in the screening process.

No program reached high test coverage. Strategies that resulted successful in reaching the target population had low participation and vice versa. Population-based programs were more effective in covering at-risk individuals. Interventions to retain eligible participants in the screening process are needed.

Question What are the best recruitment strategies of the population at risk in lung cancer screening programs, in terms of screening coverage and participation rates? Findings Test coverage is the highest in the population-based lung cancer screening programs (35-40%) and the lowest in self-referral (6.7%) or referral-based programs (4.8%). Clinical relevance There is a need to assess the effectiveness of interventions to increase participation and to decrease disengagement throughout the screening process. A joint approach from provider to patient level should be considered to increase lung cancer screening participation.