• Shina Satoh, Manav Shah, Mitchell Sungelo, Louise Falzon, Alex Makhnevich, Brett Bade, Elizabeth Cohn, Suhail Raoof, Jesse Chusid, Martin Lesser, Karina Davidson, Gerard A Silvestri, and Stuart L Cohen.
• Northwell Health, 2000 Marcus Ave., Suite 300, New Hyde Park, NY, 11042-1069, USA.
• J Gen Intern Med. 2024 Nov 13.

BackgroundFew eligible patients in the United States participate in lung cancer screening (LCS) with low-dose computed tomography (LDCT).ObjectiveWhat is the efficacy of interventions to increase LCS participation?DesignWe performed a systematic review following a prespecified protocol registered in PROSPERO (CRD42021283984). In June/July of 2021, we searched Ovid MEDLINE, Embase, Cochrane, CENTRAL, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and Epistemonikos from 1946 to October 2021 to identify studies evaluating interventions to increase LCS participation.ParticipantsThirteen of 2761 studies met inclusion criteria for data extraction. Of these, six had results available (five RCTs and one prospective observational study). The studies had predominantly White and non-Hispanic participants.Main MeasuresAn intention-to-treat analysis was used to calculate each study's relative risk (RR) to increase LCS. Effect sizes were pooled using a random-effects model with a subgroup analysis for multi- versus single-step interventions. Risk of bias was evaluated with the revised Cochrane risk-of-bias tool (RoB 2) and risk of bias in non-randomized studies of interventions (ROBINS-I).Key ResultsOverall, the proportion of screening LDCTs performed did not improve in the intervention group relative to the comparator group (RR [95% CI] of 1.30 [0.74, 2.29]), and meta-analysis indicated high heterogeneity of studies (I2 = 91%). Subgroup analysis suggests that interventions targeting multiple barriers may increase LCS participation (RR [95% CI] for multistep vs single-step; 2.68 [1.77, 4.05] vs 0.99 [0.89, 1.10], P < 0.01). Quality assessment revealed that three of five RCTs showed some concerns or high risk of bias.ConclusionEvidence on efficacy of interventions to increase LCS participation is limited due to a small number of prospective studies performed in non-diverse populations with critical risk of bias. Further, overall, studied interventions did not improve lung cancer screening participation, though interventions targeting multiple barriers may have some benefit.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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