Marjanovic Sandra, Page Andrew, Stone Emily, Currie Danielle J, Rankin Nicole M, Myers Renelle, Brims Fraser, Navani Neal, McBride Kate A
Translational Health Research Institute, Western Sydney University, Sydney, Australia.
Department of Thoracic Medicine and Lung Transplantation, St Vincent's Hospital Sydney, Sydney, Australia.
Transl Lung Cancer Res. 2024 Oct 31;13(10):2466-2478. doi: 10.21037/tlcr-24-425. Epub 2024 Oct 28.
Lung cancer screening with low-dose computed tomography has been started in some high-income countries and is being considered in others. In many settings uptake remains low. Optimal strategies to increase uptake, including for high-risk subgroups, have not been elucidated. This study used a system dynamics approach based on expert consensus to identify (I) the likely determinants of screening uptake and (II) interactions between these determinants that may affect screening uptake.
Consensus data on key factors influencing screening uptake were developed from existing literature and through two stakeholder workshops involving clinical and consumer experts. These factors were used to develop a causal loop diagram (CLD) of lung cancer screening uptake.
The CLD comprised three main perspectives of importance for a lung cancer screening program: participant, primary care, and health system. Eight key drivers in the system were identified within these perspectives that will likely influence screening uptake: (I) patient stigma; (II) patient fear of having lung cancer; (III) patient health literacy; (IV) patient waiting time for a scan appointment; (V) general practitioner (GP) capacity; (VI) GP clarity on next steps after an abnormal computed tomography (CT); (VII) specialist capacity to accept referrals and undertake evaluation; and (VIII) healthcare capacity for scanning and reporting. Five key system leverage points to optimise screening uptake were also identified: (I) patient stigma influencing willingness to receive a scan; (II) GP capacity for referral to scans; (III) GP capacity to increase patients' health literacy; (IV) specialist capacity to connect patients with timely treatment; and (V) healthcare capacity to reduce scanning waiting times.
This novel approach to investigation of lung cancer screening implementation, based on Australian expert stakeholder consensus, provides a system-wide view of critical factors that may either limit or promote screening uptake.
低剂量计算机断层扫描肺癌筛查已在一些高收入国家启动，其他国家也在考虑开展。在许多情况下，筛查的接受度仍然很低。尚未阐明增加接受度的最佳策略，包括针对高危亚组的策略。本研究采用基于专家共识的系统动力学方法来确定：（I）筛查接受度的可能决定因素；（II）这些决定因素之间可能影响筛查接受度的相互作用。
从现有文献以及通过两次涉及临床和消费者专家的利益相关者研讨会，得出关于影响筛查接受度的关键因素的共识数据。这些因素被用于绘制肺癌筛查接受度的因果循环图（CLD）。
因果循环图包含对肺癌筛查项目至关重要的三个主要视角：参与者、初级保健和卫生系统。在这些视角内确定了系统中的八个关键驱动因素，它们可能会影响筛查接受度：（I）患者耻辱感；（II）患者对患肺癌的恐惧；（III）患者健康素养；（IV）患者等待扫描预约的时间；（V）全科医生（GP）的能力；（VI）全科医生对计算机断层扫描（CT）异常后下一步措施的明确程度；（VII）专科医生接受转诊和进行评估的能力；以及（VIII）扫描和报告的医疗能力。还确定了优化筛查接受度的五个关键系统杠杆点：（I）患者耻辱感影响接受扫描的意愿；（II）全科医生转诊进行扫描的能力；（III）全科医生提高患者健康素养的能力；（IV）专科医生为患者提供及时治疗的能力；以及（V）医疗系统减少扫描等待时间的能力。
这种基于澳大利亚专家利益相关者共识的新型肺癌筛查实施调查方法，提供了一个可能限制或促进筛查接受度的关键因素的全系统视角。
