The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia.
School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Cancer Med. 2024 Aug;13(15):e70054. doi: 10.1002/cam4.70054.
Psychosocial impacts of lung cancer screening (LCS) can cause both harm to individuals and serve as barriers to screening participation and adherence. Early data suggest that the psychosocial impacts of LCS are moderated by certain factors (e.g. sociodemographic characteristics and beliefs), but evidence synthesis is lacking. This systematic review aimed to understand individual-level risk factors for psychosocial burden during LCS as a precursor to developing strategies to identify and support participants, and improve LCS engagement.
Four databases were searched for full-text articles published in English reporting any association between participant factors and psychosocial outcomes experienced during LCS. Study quality was assessed by two independent investigators; findings were synthesised narratively. The review was pre-registered with PROSPERO and adhered to PRISMA guidelines.
Thirty-five articles were included; most (33/35) studies were assessed at high or moderate risk of bias. Study designs were pre-post (n = 13), cross-sectional (n = 13), qualitative (n = 8) and mixed-methods (n = 1) and conducted primarily in the United States (n = 17). Psychological burden in LCS varied, and was often associated with younger age, female gender, current smoking status or increased smoking history, lower education, lower socio-economic group, not being married or co-habiting and experience with cancer. However, results were mixed, and non-significant associations were also reported across all factors. Beliefs (e.g. fatalism, stigma and expectation of LDCT results) and comorbid psychological burden were also linked to psychosocial outcomes, but evidence was sparse. Associations between risk perception, other participant factors and other psychosocial outcomes was inconclusive, likely reflecting individual biases in risk conceptualisation.
CONCLUSION(S): Several participant factors are consistently reported to be associated with psychosocial impacts of LCS, though study heterogeneity and high risk of bias necessitate more robust evaluation. Further research on how perceptions, beliefs and expectations can be used to improve psychosocial outcomes during LCS is needed.
肺癌筛查（LCS）的心理社会影响可能会对个人造成伤害，并成为筛查参与和坚持的障碍。早期数据表明，LCS 的心理社会影响受到某些因素（例如社会人口统计学特征和信念）的调节，但缺乏证据综合。本系统评价旨在了解 LCS 期间心理社会负担的个体风险因素，以便制定策略来识别和支持参与者，并提高 LCS 的参与度。
在英语发表的全文文章中搜索了四个数据库，这些文章报告了参与者因素与 LCS 期间经历的心理社会结果之间的任何关联。由两名独立的研究者评估研究质量；研究结果以叙述性方式综合。该综述在 PROSPERO 上进行了预先注册，并遵守了 PRISMA 指南。
共纳入 35 篇文章；大多数（33/35）研究被评估为高或中度偏倚风险。研究设计包括前后测（n=13）、横断面（n=13）、定性（n=8）和混合方法（n=1），主要在美国进行（n=17）。LCS 中的心理负担不同，通常与年龄较小、女性、当前吸烟状况或吸烟史增加、受教育程度较低、社会经济地位较低、未婚或同居以及癌症经历有关。然而，结果喜忧参半，所有因素也报告了无显著关联。信念（例如宿命论、耻辱感和对 LDCT 结果的期望）和共病心理负担也与心理社会结果相关，但证据很少。风险感知、其他参与者因素和其他心理社会结果之间的关联尚无定论，这可能反映了个体在风险概念化方面的偏见。
一些参与者因素与 LCS 的心理社会影响始终相关，但研究的异质性和高偏倚风险需要更有力的评估。需要进一步研究如何利用感知、信念和期望来改善 LCS 期间的心理社会结果。
