Interventions to increase participation in lung cancer screening programmes: a systematic review and meta-analysis

We aimed to systematically review and meta-analyse the effectiveness of interventions in increasing informed choice and participation in lung cancer screening based on low-dose computed tomography (LDCT).

Five electronic databases, Medline (PubMed version), Embase, Cinahl (Ebsco version), Scopus and Cochrane CENTRAL, were searched for randomised controlled trials, nonrandomised controlled trials and before-after studies published from 2000 until 15 March 2023. A random-effects meta-analysis was conducted to assess the effectiveness of interventions to increase rates of LDCT completion.

Out of 3483 studies identified, 14 completed and 21 ongoing studies were included in the review. Shared-decision making (SDM)+navigation (OR 4.34, 95% CI 2.50-7.54) and outreach+navigation (OR 2.20, 95% CI 1.70-2.84) resulted in a higher proportion of LDCT performed compared to the control group. Educational/informational interventions (OR 1.03, 95% CI 0.89-1.19) as well as SDM alone (OR 1.15, 95% CI 0.57-2.32) did not improve LDCT uptake, despite the second improving decisional outcomes in both intervention and control groups. Multicomponent interventions showed significantly higher LDCT uptake (OR 2.64, 95% CI 1.79-3.90), compared to unicomponent interventions (OR 1.00, 95% CI 0.87-1.14). The vast majority of interventions, including those in ongoing trials, are patient-oriented, while community-based, provider-level and system-level interventions remain rare.

Combining high-intensity patient-oriented interventions, such as patient navigation, active outreach and SDM, appears to be the most promising strategy to increase lung cancer screening uptake (low certainty of evidence). However, implementation studies are needed to evaluate interventions targeting both provider and healthcare systems level.