Barriers to Lung Cancer Screening Access from the Perspective of the Patient and Current Interventions

LDCT of the chest is the gold standard for LCS. Even with this knowledge, many at-risk patients do not take advantage of this relatively simple, noninvasive screening procedure. A number of studies have identified barriers to screening with most generally classified as cognitive barriers, access barriers, and psychological barriers (Table 1). The state of the science has advanced from descriptive studies to understand LCS behavior toward intervention development and a key component of current interventions is to mitigate barriers (see Table 1). Interventions aimed at overcoming cognitive barriers have included educational materials, community-based leaflet distribution, film and television media campaigns, social media campaigns, and decision aids to support the patient-clinician discussion about LCS.13-21 Another strategy has been to engage CHWs and other clinicians in educational efforts that target individuals eligible for screening, use of decision aids, and use of social media to increase awareness.12-27 Similarly, evidence based strategies to overcome cognitive barriers to screening include the use of CHWs as well as decision aids, particularly the practice of pairing the decision aid with face-to-face counseling or presented in a video format.18-21 Use of CHWs has also been shown effective, especially where they are members of the community or have cultural competence.23-25 To overcome access barriers, investigators have used targeted telephone outreach, patient navigation, mobile CT scanners, free screenings, and staff dedicated to LCS promotion. Having staff dedicated to both patient navigation and program coordination had a significant impact on LCS uptake.29-35 Targeted telephone outreach effectively increased LCS uptake but needs further exploration to ensure that all populations have equitable access to screening.29,30 Mobile CT scanners demonstrate effectiveness in areas not otherwise served by medical facilities.32,33 Finally, the issue of psychological barriers to screening has received little attention. Most notably, to date, there is only one intervention that effectively positively influenced psychological barriers to screening (Williams and colleagues 2022); this intervention was adapted to include CHW-led educational sessions regarding stigma once proven effective at addressing cognitive barriers to screening (ie, limited understanding of lung cancer and LCS).40 Other interventions that successfully address cognitive factors such as decision aids could also be adapted to include information about psychological barriers in the future.