Lin Xiujing, Lei Fang, Lin Jialing, Li Yonglin, Chen Qiuhong, Arbing Rachel, Chen Wei-Ti, Huang Feifei
Author Affiliations: School of Nursing, Fujian Medical University (Mss X Lin, J Lin, Li, and Q Chen, and Dr Huang), Fuzhou, China; School of Nursing, University of Minnesota (Dr Lei), Twin Cities, Minneapolis; and School of Nursing, University of California Los Angeles (Dr W-T Chen and Ms Arbing).
Cancer Nurs. 2024 Mar 18. doi: 10.1097/NCC.0000000000001334.
Promoting lung cancer screening (LCS) is complex. Previous studies have overlooked that LCS behaviors are stage based and thus did not identify the characteristics of LCS interventions at different screening stages.
The aims of this study were to explore the characteristics and efficacy of interventions in promoting LCS decision making and behaviors and to evaluate these interventions.
We conducted a study search from the inception of each bibliographic database to April 8, 2023. The precaution adoption process model was used to synthesize and classify the evidence. The RE-AIM framework was used to evaluate the effectiveness of LCS programs. Heterogeneity tests and meta-analysis were performed using RevMan 5.4 software.
We included 31 studies that covered 4 LCS topics: knowledge of lung cancer, knowledge of LCS, value clarification exercises, and LCS supportive resources. Patient decision aids outperformed educational materials in improving knowledge and decision outcomes with a significant reduction in decision conflict (standardized mean difference, 0.81; 95% confidence interval, -1.15 to -0.47; P < .001). Completion rates of LCS ranged from 3.6% to 98.8%. Interventions that included screening resources outperformed interventions that used patient decision aids alone in improving LCS completion. The proportions of reported RE-AIM indicators were highest for reach (69.59%), followed by adoption (43.87%), effectiveness (36.13%), implementation (33.33%), and maintenance (9.68%).
Evidence from 31 studies identified intervention characteristics and effectiveness of LCS interventions based on different stages of decision making.
It is crucial to develop targeted and systematic interventions based on the characteristics of each stage of LCS to maximize intervention effectiveness and reduce the burden of lung cancer.
推广肺癌筛查（LCS）是一项复杂的工作。以往的研究忽略了肺癌筛查行为是分阶段进行的，因此未能识别不同筛查阶段肺癌筛查干预措施的特点。
本研究旨在探讨促进肺癌筛查决策和行为的干预措施的特点和效果，并对这些干预措施进行评估。
我们从每个文献数据库建立之初至2023年4月8日进行了研究检索。采用预防采用过程模型对证据进行综合和分类。使用RE-AIM框架评估肺癌筛查项目的有效性。使用RevMan 5.4软件进行异质性检验和荟萃分析。
我们纳入了31项研究，这些研究涵盖4个肺癌筛查主题：肺癌知识、肺癌筛查知识、价值澄清练习和肺癌筛查支持资源。在提高知识水平和决策结果方面，患者决策辅助工具优于教育材料，决策冲突显著减少（标准化均差，0.81；95%置信区间，-1.15至-0.47；P <.001）。肺癌筛查的完成率在3.6%至98.8%之间。在提高肺癌筛查完成率方面，包含筛查资源的干预措施优于仅使用患者决策辅助工具的干预措施。报告的RE-AIM指标比例最高的是覆盖范围（69.59%），其次是采用率（43.87%）、有效性（36.13%）、实施率（33.33%）和维持率（9.68%）。
31项研究的证据确定了基于不同决策阶段的肺癌筛查干预措施的特点和有效性。
根据肺癌筛查各阶段的特点制定有针对性的系统干预措施，以最大限度地提高干预效果并减轻肺癌负担，这一点至关重要。
