Salman Maira, Cotton Alice, Humphrey Ada, Domun Tania, Cheng Calvin, Judah Gaby
Imperial College London, London, UK
KCL, London, London, UK.
BMJ Open Respir Res. 2025 Jul 21;12(1):e003127. doi: 10.1136/bmjresp-2024-003127.
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.
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.
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.
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).
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.
肺癌是全球癌症死亡的主要原因。对高危个体进行低剂量CT（LDCT）筛查可通过早期发现降低死亡率，此时治疗可能治愈。在存在正式筛查项目的国家，符合条件人群的参与率仍然很低。了解参与的障碍有助于确定支持参与的干预措施。
通过对现有文献的综述，确定作为肺癌筛查形式的LDCT筛查意向和接受度的障碍及促进因素。
使用了三个数据库并进行了灰色文献检索。研究纳入标准：2001年至2024年期间以英文发表；关注患者报告的心理障碍和促进因素以及与首次LDCT作为肺癌筛查方法的接受度（包括接受意向）相关。从论文中提取决定因素，并确定这些因素是被报告为障碍、促进因素还是两者皆有。然后将决定因素映射到理论领域框架（TDF）领域，以采用基于理论的方法对决定因素进行分类。
从最初的2491个结果中，纳入了72篇论文（67%探讨了筛查意向），这些论文报告了涵盖10个TDF领域的34个变量。在TDF的“情感”领域分类的恐惧（因宿命论导致的对肺癌诊断的恐惧（22项研究）或对筛查程序的恐惧（13项研究））是最常报告的障碍，其次是“环境背景和资源”障碍中的程序成本（28项研究）、就诊不便（24项研究）和知识缺乏（24项研究）（TDF：知识）。最常确定的促进因素是临床医生的推荐（26项研究）（TDF：社会影响）和认为参加筛查有个人益处（25项研究）（TDF：对后果的信念）。
为了提高筛查的参与率，应设计并测试针对这些决定因素的干预措施。这些措施可能包括减轻对筛查的恐惧、降低就诊成本以及促进临床医生认可的干预措施。
