From Stated Preferences to Sustained Participation in Low-Dose Computed Tomography Lung Cancer Screening: A Stage-Resolved Narrative Review

Background: Low-dose computed tomography lung cancer screening (LDCT-LCS) reduces lung cancer mortality among eligible high-risk adults, yet sustained participation remains challenging. Existing studies frequently combine stated willingness, screening decisions, initial completion, and repeated participation as a single outcome or summarize determinants as undifferentiated barriers. A clearer understanding of how patient preferences translate into screening behaviors across successive stages of the screening pathway is needed. Methods: This narrative review was informed by searches of PubMed, Web of Science Core Collection, and Scopus conducted on August 30, 2026, with a targeted PubMed and Crossref update on September 1, 2026. Evidence was organized across five analytical domains: stated preferences, screening intention, decision, initial uptake, and rescreening and sustained participation. Study designs, outcome ascertainment, and study-level limitations informed the synthesis. Results: Patients value screening outcomes and service attributes, including cost, location, invitation processes, appointment arrangements, and navigation. Few studies link stated preferences to subsequent screening events in the same individuals. Randomized multicomponent navigation interventions improved initial uptake in the studied settings, while one factorial trial found that coordinated clinician and patient reminders improved a single 9– 15-month return. Observational and qualitative studies identify access, communication, beliefs, and screening experiences associated with participation. Direct longitudinal evidence for preference-to-multiround participation remains limited. Conclusion: A stage-resolved approach distinguishes preference elicitation, intention, decision quality, verified completion, and longitudinal participation. The fifth domain encompasses the first recommended rescreening and sustained participation across multiple eligible rounds. Patient-centered screening combines informed decisions with feasible implementation and longitudinal support. The framework accommodates reconsideration, informed discontinuation, and re-entry across the screening pathway.