Patient barriers and facilitators to lung cancer screening uptake and intention to screen: a systematic review using the Theoretical Domains Framework

BACKGROUND: Lung cancer is the leading cause of cancer deaths worldwide. Screening high-risk individuals with low-dose CT (LDCT) reduces mortality through earlier detection, when treatment may be curable. In countries where formal screening programmes exist, uptake among eligible populations remains low. Understanding barriers to uptake could help identify interventions to support attendance. AIM: To identify barriers and facilitators to intention to screen and uptake of LDCT as a form of lung cancer screening, from a review of existing literature. METHOD: Three databases were used along with a grey literature search. Inclusion criteria were studied: published in English between 2001 and 2024; looking at patient-reported psychological barriers and facilitators and related to uptake (including intent to uptake) of first LDCT as method of lung cancer screening. Determinants were extracted from the papers, and whether these were reported as a barrier, facilitator or both. Determinants were then mapped to the Theoretical Domains Framework (TDF) domains to classify determinants using a theory-based approach. RESULTS: From an initial 2491 results, 72 papers were included (67% explored intention to screen), which reported 34 variables covering 10 TDF domains. Fear (of either lung cancer diagnosis due to fatalism (22 studies) or of screening procedure (13)), categorised in TDF domain Emotion, was the most frequently reported barrier followed by Environmental Context and Resource barriers of cost of procedure (28), inconvenience of attending (24) and lack of knowledge (24) (TDF: Knowledge). Most frequently identified facilitators were clinician recommendation (26) (TDF: Social Influence) and perceived personal benefit from attending screening (25) (TDF: Beliefs about Consequences). CONCLUSION: To increase uptake in screening, interventions addressing these determinants should be designed and tested. These could include interventions to mitigate fear of screening, reduce the costs of attending and promote clinician endorsement.