Background/Aims
Following the clinical effectiveness of low dose computed tomography (LDCT) shown in landmark trials, lung cancer screening (LCS) programs are being designed and implemented globally. Early data suggests that the psychosocial impacts of LCS are influenced by program factors, but evidence synthesis is needed. This systematic review aimed to elucidate the impact of service-level factors on psychosocial outcomes to inform optimal LCS program design.
Methods
Medline, Embase, PsycINFO and CINAHL databases were searched from inception to June 2022. Inclusion criteria were full-text articles published in English that reported an association between any program factors and psychosocial outcomes experienced during LCS. Study quality was assessed by two independent investigators. Results were extracted independently by two researchers and synthesised narratively.
Results
From 5,520 unique records identified via search, 130 articles underwent full-text review and 29 articles met inclusion criteria. 27 studies were assessed at high or moderate risk of bias. Quality ratings were impacted by a lack of randomised or controlled designs, use of non-validated and self-report measures, and small sample sizes. Study designs were RCTs (n=3), pre-post (n=6), cross-sectional (n=11), mixed-methods (n=1), and qualitative (n=8) studies, and conducted primarily in the USA (n=22).
Targeted interventions were examined in 18 studies. Findings suggested that (a) smoking cessation interventions can improve readiness or motivation to quit smoking, and (b) shared decision-making and the use of patient decision aids can reduce decisional conflict about LCS. However, impacts of interventions on general psychological outcomes (e.g., anxiety, distress) were varied.
Associations between some service design elements and psychological outcomes were found. High-value discussion with a clinician, either via shared decision-making for LCS or communication following LDCT result, was paramount for reducing psychological burden in multiple studies, potentially modified by a patient’s trust in their provider. The LDCT scan experience was non-consequential for most participants in 2 studies. Two additional studies suggested that earlier non-LDCT results (e.g., EarlyCDT-Lung blood test results) may prime patients’ subsequent psychological experiences of LDCT results.
Conclusion
Certain program factors are reportedly associated with psychosocial impacts of LCS, but study heterogeneity and quality necessitate testing in real-world settings. Future research should be directed at (a) evaluating the role of risk and result information and communication methods on psychosocial outcomes during LCS, (b) measuring psychosocial impact of LCS program factors in real-world settings, and (c) developing feasible methods of managing psychosocial experiences which balance with the implementation requirements of large-scale screening programs.