Background: Risk-tailored cancer screening tailors screening to individual risk rather than the mostly one-size-fits-all approach of organised population screening programs designed for the average person. There is good evidence that risk-tailored screening has the potential to increase the net benefits of screening programs and reduce related harms, if implemented well. However successful implementation will depend on acceptability.
Aim: We aimed to explore the views among a range of Australian stakeholders i.e., public, general practitioners (GPs), key informants and people at high-risk of lung cancer on the acceptability and feasibility of risk-tailored screening to identify key determinants, barriers and facilitators to inform future implementation.
Methods: We used qualitative and implementation research to inform study design and data analysis for four studies. Semi-structured interviews were conducted with public participants (40); GPs (20); key informants (47) including consumer advocates, clinical experts, policy makers, and researchers; and individuals at high-risk of lung cancer (39). Data were analysed thematically and/or using implementation frameworks.
Results: Findings suggest that risk-tailored cancer screening in the population is acceptable and feasible in principle, although a reduced screening frequency or exclusion from a screening program for those deemed low risk may not initially be acceptable, especially for common cancers with minimally invasive screening. There was some divergence in stakeholder views on factors that determine acceptability and barriers to implementation. For example, the public prioritised the sense of security screening brings; GPs were not currently convinced of the net benefits associated with risk-tailored screening and had concerns that changes in screening advice could cause patient confusion; key informants were optimistic but had concern about the impact of the reluctance of those at low-risk to reduce screening frequency, the variable skill level in providers, who should deliver screening, the potential for confusing public health messages and competing health costs. Individuals at high-risk were motivated to attend lung cancer screening however capability and opportunity impacted on participation.
Conclusions: We make 6 recommendations to inform a roadmap for implementation of risk-tailored cancer screening. They include engagement of stakeholders from planning through to implementation; tailoring public communication interventions; addressing public and provider uncertainty; developing targeted professional education to ensure access to evidence and appropriate skill set; acknowledging that different cancer types may need different strategies; and prioritising opportunity for engagement in screening to increase participation.