Decisional needs for anal cancer screening among high-risk populations: A systematic review

This systematic review aimed to identify and synthesize decisional needs (i.e., factors that adversely affect decision quality) of anal cancer screening among high-risk populations.

MEDLINE (1946), Embase (1974), CINAHL (1937), and PsycINFO (1806) were searched from inception to December 14, 2025. Studies examining anal cancer screening decisional needs among high-risk populations identified by the International Anal Neoplasia Society were eligible. Two reviewers conducted title/abstract, full-text screening and data extraction independently. Study quality was assessed using the Mixed Methods Appraisal Tool. Directed content analysis was used to synthesize decisional needs by the Ottawa Decision Support Framework.

Twenty-two studies involving 6522 participants were included. Twelve cross-sectional and 10 qualitative studies were conducted in the United States, Canada, Australia, and France. The most reported decisional needs were inadequate knowledge (19 studies), inadequate support or resources (15 studies), and unrealistic expectations regarding personal susceptibility to anal cancer or human papillomavirus (seven studies). Knowledge gaps concerned anal cancer risk, screening procedures, and results interpretation. Support needs included insufficient guidance, emotional concerns and limited access.

High-risk populations lack the information and support for anal cancer screening decisions. Implementation should combine tailored risk communication, non-stigmatizing discussion, values clarification, and clear follow-up pathways.