"What do I think about implementing lung cancer screening? It all depends on how." Acceptability and feasibility of lung cancer screening in Australia: The view of key stakeholders about health system factors

Rachael H Dodd; Ashleigh R Sharman; Henry M Marshall; Mei Ling Yap; Emily Stone; Joel Rhee; Sue McCullough A O M; Nicole M Rankin

doi:10.1371/journal.pone.0283939

"What do I think about implementing lung cancer screening? It all depends on how." Acceptability and feasibility of lung cancer screening in Australia: The view of key stakeholders about health system factors

PLoS One. 2023 Apr 5;18(4):e0283939. doi: 10.1371/journal.pone.0283939. eCollection 2023.

Authors

Rachael H Dodd^{1

2}, Ashleigh R Sharman², Henry M Marshall³, Mei Ling Yap^{2

4

5

6}, Emily Stone⁷, Joel Rhee^{8

9}, Sue McCullough A O M¹⁰, Nicole M Rankin¹¹

Affiliations

¹ The Daffodil Centre, A Joint Venture Between Cancer Council NSW and The University of Sydney, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
² Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
³ University of Queensland Thoracic Research Centre and Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia.
⁴ Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute, UNSW Sydney, Liverpool, New South Wales, Australia.
⁵ Liverpool and Macarthur Cancer Therapy Centres, Western Sydney University, Campbelltown, New South Wales, Australia.
⁶ George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia.
⁷ Department of Thoracic Medicine and Lung Transplantation, St. Vincent's Hospital, University of NSW, Darlinghurst, New South Wales, Australia.
⁸ School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia.
⁹ Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
¹⁰ TOGA Consumer Advisory Panel, Melbourne, Victoria, Australia.
¹¹ Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.

Abstract

Background: Lung cancer is the number one cause of cancer death worldwide. Although international trials demonstrate that targeted screening using low dose computed tomography (LDCT) significantly reduces lung cancer mortality, implementation of screening in the high-risk population presents complex health system challenges that need to be thoroughly understood to support policy change.

Aim: To elicit health care providers' and policymakers' views about the acceptability and feasibility of lung cancer screening (LCS) and barriers and enablers to implementation in the Australian setting.

Methods: We conducted 24 focus groups and three interviews (22 focus groups and all interviews online) in 2021 with 84 health professionals, researchers, and current cancer screening program managers and policy makers across all Australian states and territories. Focus groups included a structured presentation about lung cancer and screening and lasted approximately one hour each. A qualitative approach to analysis was used to map topics to the Consolidated Framework for Implementation Research.

Results: Nearly all participants considered LCS to be acceptable and feasible but identified a wide range of implementation challenges. Topics (five specific to health systems and five cross-cutting with participant factors) identified were mapped to CFIR constructs, of which 'readiness for implementation', 'planning' and 'executing' were most salient. Health system factor topics included delivery of the LCS program, cost, workforce considerations, quality assurance and complexity of health systems. Participants strongly advocated for streamlined referral processes. Practical strategies to address equity and access, such as using mobile screening vans, were emphasised.

Conclusions: Key stakeholders readily identified the complex challenges associated with the acceptability and feasibility of LCS in Australia. The barriers and facilitators across health system and cross-cutting topics were clearly elicited. These findings are highly relevant to the scoping of a national LCS program by the Australian Government and a subsequent recommendation for implementation.

Copyright: © 2023 Dodd et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia
Early Detection of Cancer* / methods
Feasibility Studies
Focus Groups
Humans
Lung Neoplasms*

Grants and funding

This study was financially supported by an Australian National Health and Medical Research Council (NHMRC) Ideas Grant (2019/GA65812) awarded to NMR. This study was also financially supported by a Metro North Hospital and Health Service (Queensland, Australia) Clinical Academic Fellowship and an NHMRC Investigator Grant awarded to HMM. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.