Systems mapping: a novel approach to national lung cancer screening implementation in Australia

Sandra Marjanovic, Andrew Page, Emily Stone, Danielle J. Currie, Nicole M. Rankin, Renelle Myers, Fraser Brims, Neal Navani, Kate A. McBride

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    Abstract

    Background: Lung cancer screening with low-dose computed tomography has been started in some high-income countries and is being considered in others. In many settings uptake remains low. Optimal strategies to increase uptake, including for high-risk subgroups, have not been elucidated. This study used a system dynamics approach based on expert consensus to identify (I) the likely determinants of screening uptake and (II) interactions between these determinants that may affect screening uptake. 

    Methods: Consensus data on key factors influencing screening uptake were developed from existing literature and through two stakeholder workshops involving clinical and consumer experts. These factors were used to develop a causal loop diagram (CLD) of lung cancer screening uptake. 

    Results: The CLD comprised three main perspectives of importance for a lung cancer screening program: participant, primary care, and health system. Eight key drivers in the system were identified within these perspectives that will likely influence screening uptake: (I) patient stigma; (II) patient fear of having lung cancer; (III) patient health literacy; (IV) patient waiting time for a scan appointment; (V) general practitioner (GP) capacity; (VI) GP clarity on next steps after an abnormal computed tomography (CT); (VII) specialist capacity to accept referrals and undertake evaluation; and (VIII) healthcare capacity for scanning and reporting. Five key system leverage points to optimise screening uptake were also identified: (I) patient stigma influencing willingness to receive a scan; (II) GP capacity for referral to scans; (III) GP capacity to increase patients' health literacy; (IV) specialist capacity to connect patients with timely treatment; and (V) healthcare capacity to reduce scanning waiting times. 

    Conclusions: This novel approach to investigation of lung cancer screening implementation, based on Australian expert stakeholder consensus, provides a system-wide view of critical factors that may either limit or promote screening uptake.

    Original languageEnglish
    Pages (from-to)2466-2478
    Number of pages13
    JournalTranslational Lung Cancer Research
    Volume13
    Issue number10
    DOIs
    Publication statusPublished - 2024

    Bibliographical note

    Publisher Copyright:
    © 2024 AME Publishing Company. All rights reserved.

    Keywords

    • Delivery of Health Care
    • Lung neoplasms
    • mass screening
    • system dynamics

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