Navigation, not leaflets, gets people to lung screening

Design

Systematic review and meta-analysis of randomised and non-randomised studies

Population

14 completed studies of lung cancer screening invitees

Primary outcome

Completion of low-dose CT screening

Effect

SDM + navigation OR 4.34 (2.50–7.54); education alone OR 1.03 (0.89–1.19)

A systematic review included 14 completed studies (randomised, non-randomised and before-after) testing ways to increase uptake of low-dose CT lung cancer screening, and identified 21 more in progress.

Combining shared decision-making with patient navigation was associated with a large rise in completed scans (OR 4.34, 95% CI 2.50 to 7.54), and outreach plus navigation with a smaller one (OR 2.20, 1.70 to 2.84). Education or information alone did not help (OR 1.03), and nor did shared decision-making alone (OR 1.15), though it improved decision quality. Multicomponent approaches outperformed single components (OR 2.64 vs 1.00). Certainty was low.

For radiology departments running or planning screening programmes, the implication is that the bottleneck is less often information than practical help: someone to book, remind and guide people through the pathway.

Almost all interventions targeted patients; provider- and system-level approaches remain largely untested.

• Build patient navigation into lung screening programmes, not only information materials.
• Pair shared decision-making with practical booking support.
• Use active outreach to eligible people rather than waiting for referral.
• Measure completed scans, not invitations sent, as the programme outcome.

Why it matters

Screening only reduces mortality if eligible people complete the scan, and leaflets did not achieve that.

Don't overread it

Low certainty and a search ending in March 2023; newer approaches are not captured.

The statistics, in plain English

An odds ratio of 4.34 means the odds of completing a scan were more than four times higher with navigation plus shared decision-making. An odds ratio of 1.03 with an interval spanning 1 means education made no measurable difference.

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