Lung screening uptake: navigation and outreach worked, leaflets did not

Design

Systematic review and random-effects meta-analysis of randomised, non-randomised and before–after studies

Population

People eligible for low-dose CT lung cancer screening (14 completed studies)

Primary outcome

Low-dose CT completion

Effect

SDM plus navigation OR 4.34 (2.50 to 7.54); education alone OR 1.03 (0.89 to 1.19)

A systematic review in the European Respiratory Review included 14 completed and 21 ongoing studies of interventions to increase participation in low-dose CT lung cancer screening.

Shared decision-making combined with patient navigation raised low-dose CT completion markedly (OR 4.34, 95% CI 2.50 to 7.54), as did active outreach with navigation (OR 2.20, 1.70 to 2.84). Educational or informational interventions (OR 1.03) and shared decision-making alone (OR 1.15) did not. Multicomponent interventions outperformed single-component ones (OR 2.64 vs 1.00). Almost all interventions targeted patients; provider and system-level approaches were rarely tested. Certainty was low.

For radiology departments running screening, a leaflet and a booking line are not enough. A named navigator who contacts eligible people, helps them decide and books the scan is what moved uptake. India has no national lung screening programme; the lesson applies to hospital and private programmes that offer it.

• Pair shared decision-making with a navigator who books and follows up the scan.
• Use active outreach — calls or letters with direct booking — rather than passive information.
• Do not rely on leaflets or education alone to raise screening uptake.
• Track invitation-to-scan conversion so the programme can see whether its approach works.
• Build in follow-up of positive results, where navigation also matters.

Why it matters

Screening only saves lives in people who attend, and the cheapest intervention — education — did nothing.

Don't overread it

Certainty of evidence was low, and the pooled studies mixed randomised and before–after designs.

The statistics, in plain English

An odds ratio of 4.34 means the odds of completing the scan were about four times higher with navigation plus shared decision-making. Intervals for education alone and shared decision-making alone cross 1, meaning no clear effect.

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