- Design
- Systematic review and meta-analysis of randomised and non-randomised studies
- Population
- 14 completed studies of people eligible for low-dose CT lung cancer screening
- Primary outcome
- Completion of low-dose CT screening
- Effect
- SDM + navigation OR 4.34 (2.50 to 7.54); outreach + navigation OR 2.20 (1.70 to 2.84); education OR 1.03 (0.89 to 1.19)
This review pooled studies of interventions to increase participation in lung cancer screening with low-dose CT. Most interventions targeted the patient rather than the clinician or health system.
Combinations worked. Shared decision-making paired with a navigator who helped patients through the process gave the largest increase in completed scans. Outreach with navigation also helped. Educational material alone, and shared decision-making alone, did not change uptake, though shared decision-making improved patients' decisional measures.
For family physicians, the transferable point is that a personal follow-up after the invitation matters more than the content of the leaflet.
- Shared decision-making combined with navigation gave the largest effect (OR 4.34).
- Outreach plus navigation also worked (OR 2.20).
- Education alone and shared decision-making alone did not raise uptake.
- Multicomponent approaches outperformed single components.
- In India, low-dose CT screening is not part of a national programme; the lesson applies to any screening invitation.
Why it matters
Most practices rely on letters and leaflets, which this analysis found made no difference.
Don't overread it
The certainty of evidence was rated low, and most studies were from high-income health systems with organised screening.
The statistics, in plain English
An odds ratio of 4.34 means the odds of being screened were about four times higher. Education's interval from 0.89 to 1.19 includes 1, so it showed no effect. Low certainty means future studies could change these estimates.
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