Healthcare professionals’ perspectives on a population-based lung cancer screening programme in Flanders: a cross-sectional survey study

Abstract

Background

Lung cancer is the leading cause of cancer mortality worldwide. In Belgium, this burden is comparable, with high rates of late-stage diagnosis and correspondingly poor outcomes. While low-dose computed tomography (LDCT) screening has proven to be effective in reducing mortality among high-risk groups, Belgium has not yet implemented a population-based screening programme. The success of such a programme will not solely depend on public uptake, but also on the active support of healthcare providers (HCPs), who are central to its successful implementation. This study explores the perspectives and perceptions of Flemish HCPs towards lung cancer screening.

Methods

A cross-sectional survey was distributed to general practitioners, pharmacists, tobacco treatment specialists, and medical specialists in Flanders (Belgium). The questionnaire included items assessing perceptions toward lung cancer screening, perceived benefits and barriers, clinical readiness, and expectations regarding programme implementation. Descriptive and inferential statistics were used to analyse the data, including subgroup analyses based on gender, professional role, and years of experience.

Results

A total of 415 HCPs participated in the survey. Overall, 91% considered population-based lung cancer screening important or very important, and 86.3% anticipated a positive impact on the healthcare system. More than 62% reported a high willingness to refer patients once a screening programme is implemented. The most frequently cited barriers to successful implementation included insufficient training (47%), limited staff or resources (37%), and logistical challenges (32%). An exploratory correlation analysis further revealed a significant positive association between perceived healthcare impact and willingness to refer patients.

Conclusions

HCPs in Flanders generally support the implementation of a population-based lung cancer screening programme. However, addressing practical and organisational barriers will be crucial to ensure sustainable engagement. Promoting interprofessional collaboration, strengthening documentation of smoking history, and integrating screening workflows into existing healthcare systems may enhance efficiency and equity.

Clinical trial number

Not applicable.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-026-14255-1.

Background

Lung cancer remains the leading cause of cancer-related mortality worldwide [1], including in Belgium, where it constitutes a major contributor to both cancer incidence and mortality [2, 3]. The prognosis is strongly stage-dependent, with markedly better survival rates when the disease is detected early [4, 5]. However, most diagnoses are still made at an advanced stage, underscoring the need for effective early detection strategies [5, 6]. Low-dose computed tomography (LDCT) has emerged as an effective screening method to reduce lung cancer mortality in high-risk populations but is also associated with potential harms such as false-positive findings, overdiagnosis, incidental findings, psychological burden, and cumulative radiation exposure [6–8]. Large-scale randomised controlled trials such as the NLST, NELSON and MILD studies demonstrated that LDCT can detect lung cancer at earlier stages and reduce disease-specific mortality significantly [6, 9, 10]. In response, several countries have implemented national or regional lung cancer screening programmes targeting high-risk individuals, typically based on age and smoking history [11, 12].

Belgium, where population-based cancer screening programmes are organised at the regional level, has not yet implemented a population-based lung cancer screening initiative [13]. In Flanders, a region of Belgium, organised screening currently exists for breast, colorectal, and cervical cancer, with central coordination. These programmes are characterised by systematic identification of the target population, centralised invitations, and monitoring of participation and outcomes. Participation in breast and colorectal cancer screening is offered free of charge, while cervical cancer screening may involve limited out-of-pocket costs under Belgium’s mandatory social health insurance system. Within this organisational model, general practitioners do not initiate screening invitations but play a complementary role by informing patients, addressing concerns, facilitating referral when needed, and integrating screening results into ongoing care.

As part of ongoing efforts to assess the feasibility of population-based lung cancer screening, the ZORALCS pilot study, launched in 2025 in a Flemish region, is evaluating the feasibility of a population-based lung cancer screening programme [14]. Furthermore, a growing body of research, including the study by García et al., has shown that screening candidates in Belgium are generally open to participation in lung cancer screening [15]. They noted that participation was particularly likely when the programme would be reimbursed, and when there were targeted, educational campaigns aimed at individuals with lower education or socioeconomic status [15]. However, the success of a future lung cancer screening programme does not rely solely on public acceptance. Its feasibility and long-term sustainability also depend on the engagement and support of HCPs, particularly primary care providers, who will play a pivotal role in communication, supporting informed participation, facilitating follow-up, early symptom recognition, and integration of screening into routine care [16]. Their perspectives on lung cancer screening, including perceived benefits, concerns, implementation barriers, and necessary support, are therefore essential to understand before implementation can be considered [16–19]. International studies have indicated that HCPs’ support for lung cancer screening is often conditional [17–19]. While many endorse the potential of early detection, they also express concerns about overdiagnosis, which refers to the detection of indolent cancers that would not have caused symptoms during a patient’s lifetime, alongside logistical complexity, reimbursement, and the impact on their clinical workload [17–19]. These concerns can translate into lower referral rates and inconsistent messaging to participants [17, 19].

In Flanders, little is currently known about how HCPs perceive the possible implementation of a population-based lung cancer screening programme, or what they would need to support it in practice. Moreover, most available data originate from countries with different healthcare structures, making local insight necessary to guide region-specific implementation. This study aims to fill this knowledge gap by systematically assessing the perceptions, expectations, and needs of HCPs regarding the potential implementation of a population-based lung cancer screening programme. These insights are essential to inform policymakers, ensure clinical alignment, and design a screening programme that is both feasible and professionally supported.

Methods

This quantitative, cross-sectional survey study aimed to explore the perspectives of HCPs in Flanders, the northern region of Belgium, on the potential implementation of a population-based lung cancer screening programme. Ethical approval for the study was obtained from the Ethics Committee Research of University Hospitals Leuven (UZ Leuven)/ KU Leuven (S69748).

Survey development

A self-administered survey was developed for HCPs involved in the early detection, prevention, and treatment of lung cancer. No specific lung cancer screening protocol or eligibility criteria were presented to respondents, as the survey aimed to capture HCPs’ general perspectives on a future population-based lung cancer screening programme in a pre-implementation context, defined here as an organised, centrally coordinated programme targeting a predefined high-risk population.

The content of the survey was informed by an exploratory review of the literature conducted by the research team, which served as the conceptual basis for item development and helped identify key themes relevant to the implementation of a future population-based lung cancer screening programme. Draft items were iteratively reviewed and refined within the multidisciplinary research team to assess relevance, clarity, and applicability across professional roles. Several items were intentionally phrased broadly to capture respondents’ overall expectations regarding system-level and implementation-related consequences, rather than narrowly defined programme characteristics. Given the exploratory and descriptive aims of the study, no formal psychometric validation or cognitive interviewing was conducted.

Participants were first provided with an introductory information sheet describing the study. The questionnaire itself consisted of three sections: (i) demographic and professional background questions (8 items), and (ii) questions assessing perceptions towards lung cancer screening (12 items). In addition, a third part specifically addressed shared decision-making (SDM) in the context of lung cancer screening and the preferred approaches of HCPs within this process. The present manuscript reports only on screening-related perception items assessing participants’ perspectives, expectations, and needs; decision-making related questions were collected as part of the broader study but are outside the scope of this paper and will be presented in a separate publication.

The survey primarily comprised closed-ended, multiple-choice questions, some of which allowed for multiple selections. It also included Likert scale items to measure levels of agreement with specific statements. The web-based survey was created using the LimeSurvey platform and was accessible across multiple devices. The sequence and grouping of questions were optimised to minimise cognitive load and to promote logical flow through thematic structuring and intuitive transitions.

A formal pilot test was not conducted, given the concise nature of the items. However, the full questionnaire underwent a thorough review by the research team.

Recruitment and participants

To be eligible for participation, individuals had to meet the following criteria: they had to be currently practising in Flanders, be active in the field of lung cancer prevention, early detection, or treatment, and be 18 years of age or older. Four professional groups were targeted: general practitioners, pharmacists, tobacco treatment specialists, and medical specialists. In Belgium, tobacco treatment specialists are HCPs with diverse clinical backgrounds, including general practitioners, pharmacists, nurses, psychologists, and other allied health professionals, who have completed specialised training in smoking cessation. Participants selected one primary professional role in the survey; analyses used this classification. Medical specialists included pulmonologists, radiologists, oncologists, and thoracic surgeons. These specialties were grouped because all are directly involved in lung cancer diagnosis, treatment, and follow-up.

Participants were recruited using a multi-channel dissemination strategy. Recruitment strategies included digital flyers, email invitations sent via publicly available professional contact directories and professional organisations, and social media posts disseminated via professional networks, sector-specific journals and websites, and relevant stakeholder organisations. Participants were also encouraged to share the survey within their professional networks, resulting in a snowball dissemination component. The study invitation was phrased neutrally to minimise framing or selection bias. Data collection took place between November 1, 2024, and April 30, 2025. No incentives were provided for participation.

Given the exploratory nature of the study and the absence of a predefined hypothesis, no formal power calculation was conducted and a pragmatic sample size was pursued. Because recruitment relied on open dissemination channels, the total number of HCPs reached could not be determined, precluding calculation of a formal response rate.

Survey data analysis

The data were analysed using both descriptive and inferential statistical methods in IBM SPSS Statistics version 29.0. Participants were included in the analysis if they completed at least one item beyond the demographic section; those who completed only demographic questions were excluded. Due to the use of conditional logic within the survey and participant attrition, response rates varied across items. As such, results are reported per item, based on the number of valid responses, with sample sizes (n) specified for each analysis.

Survey items varied in type and measurement level. Items using Likert scales, numerical rating scales, or dichotomous yes/no formats were analysed using both descriptive and inferential statistics. Inferential testing was restricted to ordinal and dichotomous variables for which theoretically grounded subgroup comparisons were meaningful, while categorical multiple-choice or multiple-response items were analysed descriptively. Open comment fields accompanying these questions were reviewed qualitatively to capture additional nuances, but no formal content analysis was performed.

For inferential analyses, appropriate statistical tests were selected based on measurement level, distributional characteristics, and sample size. Depending on these factors, we used non-parametric tests and, where assumptions permitted, parametric tests (Additional file 1, Supplementary Table 1). All tests were two-tailed. To ensure consistency and avoid selective subgroup testing, all inferential analyses systematically included comparisons across gender, years of professional experience, and professional role, regardless of prior expectations or observed trends. Although medical specialists represented multiple specialties, subgroup sizes were too small to report specialty-specific distributions or analyses without risking unstable estimates and potential identifiability. Therefore, HCPs were grouped into four main categories: general practitioners, pharmacists, tobacco treatment specialists, and medical specialists. Similarly, to enable meaningful comparisons regarding professional experience, years of practice were categorised into four groups: junior (1–5 years), middle (6–14 years), expert (15–24 years), and senior (≥ 25 years). This classification was informed by the distribution of responses within the sample.

To address the risk of inflated Type I error rates due to multiple comparisons, Bonferroni-corrected alpha thresholds were applied per item, based on the number of pairwise comparisons within each subgroup factor. An initial alpha level of 0.05 was used for overall group comparisons, followed by Bonferroni-adjusted thresholds for post hoc pairwise tests. Only statistically significant results (p < adjusted α) are reported in the results section. Full test outputs, including non-significant findings, are provided in Additional File 1.

In addition, an exploratory correlation analysis was conducted to examine the association between HCPs’ perceived impact of lung cancer screening and their willingness to refer patients to a future screening programme. In the context of an organised, centrally coordinated screening programme, ‘willingness to refer’ should be interpreted as willingness to actively support participation, for example by informing patients and directing potentially eligible individuals toward participation. Because the variables were measured on bounded ordinal and numerical rating scales and did not consistently meet normality assumptions, Spearman’s rank-order correlation was used. Given the exploratory nature of this analysis and the single test performed, no Bonferroni correction was applied.

Results

Participant characteristics

In total, 627 HCPs answered at least one survey question. Of these, 212 provided demographic information only and were excluded from the analysis. The analytic sample therefore comprised 415 respondents who completed at least one item beyond the demographic section. Among these, 370 participants completed the survey in full.

The majority were female (73%), with a mean age of 41.1 years (SD = 12.5, range: 24–75). Participants represented a range of professional backgrounds, including general practitioners (49%), pharmacists (29%), tobacco treatment specialists (11%), and medical specialists (11%). The average duration of professional experience was 16.1 years (SD = 12.1), with a median of 12 years (range: 1–50). An overview of participant characteristics is provided in Table 1.

Table 1.

Participant characteristics

Characteristic	n	%
Sex
Females	305	73%
Males	110	27%
Age (years)
≤ 29 year.	92	22%
30 to 39 year.	132	32%
40 to 49 year.	73	18%
50 to 59 year.	81	20%
≥ 60 year.	37	8%
Profession
General practitioners	203	49%
Pharmacists	121	29%
Tobacco treatment specialists	44	11%
Medical specialists	47	11%
Experience (Years of experience)
Junior (1–5 years)	102	25%
Middle (6–14 years)	124	30%
Expert (15–24 years)	69	17%
Senior (≥ 25 years)	120	29%

Percentages might not add to 100% because of rounding

Perceptions towards population-based lung cancer screening

General perceptions

All 415 HCPs responded to two items assessing their general perceptions toward the implementation of a population-based lung cancer screening programme: one regarding its perceived importance and the other its anticipated impact on the healthcare system.

The perceived importance of implementing a population-based lung cancer screening programme was assessed using a 5-point Likert scale (1 = not important, 5 = very important). Responses were skewed towards higher values, with a mean of 4.32 (SD = 0.84), and both the median and mode at 5. A majority of respondents (52.3%) selected “very important”. Significant differences were observed across professional groups (Kruskal–Wallis H(3) = 33.80, p < .001) and levels of experience (H(3) = 21.78, p < .001). Post-hoc Mann–Whitney U tests with Bonferroni correction (α = 0.0083) showed that general practitioners (M = 4.08, SD = 0.91) rated screening significantly less important than pharmacists (M = 4.56, SD = 0.67, p < .001), tobacco specialists (M = 4.59, SD = 0.73, p < .001), and medical specialists (M = 4.49, SD = 0.69, p = .005). Similarly, junior professionals (M = 4.03, SD = 0.91) rated it significantly lower than middle (M = 4.34, SD = 0.77, p = .007), expert (M = 4.51, SD = 0.82, p < .001), and senior professionals (M = 4.45, SD = 0.79, p < .001). No significant gender differences were found (p = .130), nor were other pairwise comparisons significant. Full test statistics are presented in Additional file 1, Supplementary Table 2.

Perceived impact on the healthcare system was assessed using a 5-point scale (1 = very negative, 5 = very positive). The distribution was again skewed towards higher values (M = 4.08, SD = 0.70), with a median and mode of 4. Most participants rated the expected impact as positive (61.0%) or very positive (25.3%). Only a small proportion selected negative responses (3.1%), and 10.6% opted for a neutral stance. A Kruskal–Wallis test revealed significant differences between professional groups (H(3) = 41.82, p < .001), with post-hoc Mann–Whitney U tests using Bonferroni correction (α = 0.0083) confirming that general practitioners rated the impact significantly less positively than pharmacists, tobacco specialists, and medical specialists (all p < .001). Pharmacists and tobacco specialists reported the most positive views, with pharmacists having the highest mean score (M = 4.33, SD = 0.57), followed closely by tobacco specialists (M = 4.30, SD = 0.67). No significant differences were found across gender (p = .502) or experience levels (p = .073). Full test statistics are provided in the Additional file 1, Supplementary Table 3. Figure 1 visualises the combined distribution of the two aforementioned variables, illustrating how respondents’ ratings of perceived importance and anticipated impact relate to one another.

Fig. 1.

Combined distribution of ratings of the importance and impact of implementing a lung cancer screening programme. The figure displays the number of respondents for each combination of perceived importance and perceived impact ratings regarding a future population-based lung cancer screening programme. Responses are clustered toward the lower-right quadrant, indicating that many respondents rated the programme as both important and likely to have a positive impact

Perceived benefits and barriers

In addition, participants were asked to indicate the single most important perceived benefit of implementing a population-based lung cancer screening programme. A total of 414 HCPs responded to this question. The majority selected one of three closely related clinical benefits, early detection (31%), improved survival (33%), or better patient outcomes (25%), as the main advantage of screening. Together, these interrelated aspects were mentioned by 89% of respondents. Far fewer participants indicated long-term cost savings (6%), while only 2% reported that they saw no benefits at all. Among the few respondents who selected “other” (3%) and provided additional remarks in the open-text field, some expressed uncertainty about the overall benefit–risk balance of population-based lung cancer screening, noting possible false positives, radiation exposure, and the psychological burden of incidental findings. A few participants also questioned the cost-effectiveness, the relatively high number needed to screen, and whether resources might be more effectively directed toward primary prevention and smoking cessation initiatives. Full test statistics are provided in Additional file 1, Supplementary Table 4.

Participants (n = 415) were also asked about perceived barriers or challenges that could hinder the successful implementation of a population-based lung cancer screening programme in Flanders. Respondents were allowed to select multiple options. As this was a multiple-response item with broadly defined categories, reported barriers reflect respondents’ overall perceptions of implementation challenges rather than narrowly defined constructs. The most frequently reported barrier was insufficient knowledge or training about lung cancer screening (47%), followed by limited resources or personnel (37%) and logistical challenges in organising screening (32%). About one in four participants mentioned lack of time to inform or refer patients (25%) or difficulties related to the organisation and interpretation of follow-up scans (26%). Other barriers included resistance or uncertainty among patients (22%), costs for participants (17%), and ethical considerations (14%). Participants were also asked which eligibility criteria they believed should be included in a future population-based lung cancer screening programme. A total of 415 HCPs responded to this question, and respondents were allowed to select multiple options. Full test statistics are provided in Additional file 1, Supplementary Table 5.

Preferred inclusion criteria

Most participants indicated that smoking history should be part of the inclusion criteria (90%), followed by age (72%), specific medical history such as a family history of lung cancer (60%), and pre-existing lung diseases such as COPD or interstitial lung conditions (53%). A smaller proportion mentioned other health factors (20%), while only a minority believed that everyone should have the opportunity to participate without specific eligibility criteria (approximately 15%). Full test statistics are provided in Additional file 1, Supplementary Table 6.

Readiness for implementation

To assess the practical readiness of HCPs for the potential implementation of a population-based lung cancer screening programme, the survey explored both current clinical behaviours and future-oriented intentions related to screening eligibility and patient engagement.

First, 407 HCPs responded to a question about how frequently they assess smoking behaviour in new patients, a key risk factor for lung cancer. Using a 5-point scale ranging from “none or very few” to “almost all,” responses revealed substantial variation. While 35.1% of participants reported assessing smoking behaviour in almost all new patients, 18.2% indicated doing so for only a small proportion. The overall distribution leaned toward higher frequencies (M = 3.41, SD = 1.53), with a median of 4 and a mode of 5. Statistically significant differences emerged between professional groups (Kruskal–Wallis H(3) = 228.56, p < .001). Post hoc Mann–Whitney U tests with Bonferroni correction (α = 0.0083) showed that pharmacists assessed smoking behaviour significantly less frequently than general practitioners, tobacco specialists, and medical specialists (all p < .001). In addition, general practitioners reported significantly lower assessment frequencies than both tobacco treatment specialists and medical specialists (both p < .001). Figure 2 illustrates these differences, showing clear variation in assessment frequency across healthcare professions. As expected, given their role, most tobacco specialists (88.6%) reported asking almost all new patients about smoking. Gender differences were also evident: male respondents reported higher assessment rates than female colleagues (p = .002). No significant differences were found across experience levels (p = .864). Full statistics are provided in Additional file 1, Supplementary Table 7.

Fig. 2.

Assessment of smoking behaviour among new patients, by healthcare profession. This figure shows the distribution of responses to the question: “For what percentage of your new patients do you assess their smoking behaviour?”, grouped by healthcare profession. Responses ranged from “None or very few” to “Almost all.” The boxplots display the interquartile range (IQR), with the line inside the box representing the median. The “X” indicates the mean, and dots represent potential outliers. Tobacco specialists and medical specialists reported the highest levels of consistent assessment, with over 85% indicating they assess smoking behaviour in almost all new patients. In contrast, pharmacists predominantly assessed few or no patients. The figure highlights strong differences across professions (Kruskal–Wallis H(3) = 228.56, p < .001), with post hoc tests indicating that pharmacists reported significantly lower assessment frequencies than all other groups, and that general practitioners reported significantly lower assessment frequencies than tobacco treatment specialists and medical specialists (all Bonferroni-corrected p < .001)

In addition to current practices, participants were asked about their willingness to refer patients to a future screening programme, understood here as actively supporting participation (e.g., informing patients and directing potentially eligible individuals toward screening), using a 10-point scale (1 = not at all willing, 10 = very willing). Across the sample (N = 414), HCPs indicated a high willingness to refer patients to a future population-based lung cancer screening programme (M = 8.67, SD = 1.58). The distribution was skewed toward the upper end of the scale, with a median of 9 and a mode of 10. Notably, over 62% of respondents selected a score of 9 or 10, reflecting very high referral intentions. A Kruskal–Wallis test revealed a significant difference between professional groups (H(3) = 11.29, p = .010). However, after Bonferroni correction, only the difference between pharmacists and medical specialists remained statistically significant (p = .003), with specialists expressing higher willingness. Medical specialists had the highest mean willingness to refer (M = 9.02, SD = 1.80), followed by general practitioners (M = 8.74, SD = 1.60), tobacco specialists (M = 8.64, SD = 1.22), and pharmacists (M = 8.45, SD = 1.57). No significant differences were found based on gender (p = .704) or years of professional experience (p = .090). Full test statistics are presented in Additional file 1, Supplementary Table 8.

Exploratory correlations between perceptions and behavioural intentions

To explore how key perceptions relate to professional intentions, a non-parametric correlation was conducted. A Spearman correlation revealed a statistically significant positive association between perceived impact of lung cancer screening (1 = very negative, 5 = very positive) and willingness to refer patients (1 = Not willing at all, 10 = Very willing) (ρ = 0.406, p < .001, N = 414), as illustrated in Fig. 3. This suggests that HCPs who anticipate a more positive impact on the healthcare system are also more inclined to refer patients to a future screening programme. Full test statistics are shown in Additional file 1, Supplementary Table 9.

Fig. 3.

Correlation between HCPs’ perceived impact of lung cancer screening and their willingness to refer patients, visualised as a bubble chart

Discussion

This exploratory, pre-implementation study provides important insights into high-level perceptions among HCPs in Flanders regarding the potential implementation of a population-based lung cancer screening programme, in a context where the organisational model has not yet been defined. Taken together, the findings indicate strong general support for such a programme, with most respondents rating its importance highly and anticipating a positive impact on the healthcare system. This aligns with international literature showing that many HCPs acknowledge the value of early detection to reduce lung cancer mortality [20]. Such endorsement is promising in the context of growing policy interest in expanding preventive care [1, 21].

Although overall perceptions were favourable, significant differences were observed between professional groups. General practitioners reported significantly lower scores for overall positive perceptions towards lung cancer screening than pharmacists, tobacco treatment specialists, and medical specialists. Differences by professional role and experience may partly reflect variation in clinical exposure to high-risk patients or lung cancer cases, although this was not directly measured in this survey. Given their coordinating role in primary care and broad clinical responsibilities, general practitioners may also be more aware of potential organisational implications of a future screening programme. Concerns related to workload and competing priorities are frequently cited in the literature as barriers and may therefore contribute to more cautious attitudes among general practitioners [19, 20, 22]. However, this interpretation remains speculative, as the present study did not assess associations between professional attitudes and specific perceived barriers within subgroups.

In contrast, international experience shows that general practitioner engagement is vital for programme success. In Croatia and Estonia, for instance, the nationally coordinated lung cancer screening programmes rely heavily on general practitioners as the primary entry point for patient identification and risk assessment, while diagnostic imaging and follow-up are centralised in regional hospitals [23]. In these settings, general practitioners are supported through structured guidance on eligibility criteria and referral procedures, access to integrated digital referral and feedback systems, and informational resources to facilitate communication about screening benefits and potential harms. Together, these organisational features have been associated with encouraging participation rates in population-based screening programmes [23, 24]. While these models differ from a centrally invited Flemish pathway, they illustrate how structured guidance and integrated systems can support HCP engagement. At the same time, the strong willingness to refer observed among pharmacists, tobacco treatment specialists, and medical specialists in this study suggests that these professionals could play complementary roles in patient education and communication. More specifically, pharmacists and tobacco treatment specialists could support low-threshold patient information, documentation of smoking status where relevant, stigma-sensitive communication, and active linkage to smoking cessation services, while medical specialists may contribute to governance of follow-up pathways and consistent messaging about downstream diagnostic steps. Leveraging this broader professional network could help distribute workload more evenly and improve accessibility [25].

While interprofessional collaboration can be promising, participants also identified several barriers that could hinder effective implementation. The most frequently cited obstacles were insufficient training, limited time for counselling and referral, and a lack of staff or technical resources. Addressing these constraints will require coordinated investment in professional training and integration of screening workflows into existing information systems. Patient-related barriers were also noted, including resistance or uncertainty toward participation, often linked to low awareness, stigma surrounding smoking-related diseases, and potential cost-related concerns in the Belgian context, where co-payments may influence participation, particularly among lower socioeconomic groups. Evidence suggests that clear communication about screening benefits and potential harms can mitigate these concerns and improve participation, particularly among lower socioeconomic groups [26, 27].

Positive perceptions and addressing key barriers before implementation are important first steps, but the ability to accurately identify and reach the high-risk target population will also be a critical determinant of the success of a future lung cancer screening programme. Since screening has not yet been implemented in Belgium, patients’ smoking status and other risk factors are not systematically recorded in primary care. Integrating smoking history and relevant health information into electronic health records could greatly facilitate preselection and reduce administrative burden for HCPs. Our findings indicate that tobacco treatment specialists already document smoking behaviour relatively consistently, whereas general practitioners, pharmacists, and medical specialists do so less frequently, with pharmacists reporting the lowest rates of assessment. This suggests a need to strengthen routine documentation practices across all professional groups. Evidence from the UK Lung Cancer Screening (UKLS) trial and subsequent modelling studies shows that risk-based recruitment, using tools such as the Liverpool Lung Project (LLP) or PLCOm2012 models, enhances cost-effectiveness and ensures that individuals at highest risk are prioritised for screening [25, 28–30]. Beyond risk modelling, experiences from Croatia further highlight the importance of practical implementation structures, where general practitioners identify eligible high-risk individuals and refer them via a national digital platform integrated with radiology services [24]. Combining such coordinated primary care involvement with systematic documentation and validated risk prediction tools may offer an efficient and scalable approach to eligibility assessment and programme implementation.

Together, these findings highlight that the success of a future lung cancer screening programme in Flanders will depend not only on technological readiness, but also on organisational readiness, active engagement and support of HCPs. Strengthening interprofessional collaboration, ensuring adequate training, and embedding clear decision-making pathways within existing care structures will therefore be key to achieving an equitable and successful implementation. Importantly, lung cancer screening should be positioned as secondary prevention that complements, rather than replaces, primary prevention, with tobacco control and accessible smoking cessation support remaining central to reducing lung cancer incidence and avoiding the widening of existing inequalities.

Strengths and limitations

This study provides valuable insights into HCPs’ perspectives on the implementation of population-based lung cancer screening in Flanders. While previous research in Flanders has examined public attitudes towards lung cancer screening, this study represents one of the first region-wide assessments of HCPs’ perspectives, including a broad range of professional roles, experience levels, and age groups. With 415 respondents from across Flanders, the study enables an initial, high-level exploration of perspectives across the healthcare system and allows meaningful interprofessional comparisons. The use of both descriptive and inferential analyses provides a nuanced overview of perceived importance, anticipated impact, barriers, and readiness for implementation, thereby offering relevant evidence to inform future policy and professional engagement strategies.

Several limitations should, however, be acknowledged. First, participation was voluntary and recruitment relied on professional networks and digital dissemination, meaning that the sample cannot be considered fully representative of all Flemish HCPs. No formal assessment of self-selection bias was conducted, and it is possible that HCPs with a particular interest in lung cancer screening or prevention were more likely to participate. Consequently, the findings should be interpreted as indicative rather than generalisable, and as reflecting high-level perceptions in a pre-implementation context rather than definitive professional positions. Second, the use of self-reported data may have introduced social desirability bias, particularly in questions concerning perceptions or behavioural intentions. In addition, the relatively modest sample size may have limited statistical power for certain subgroup comparisons, meaning that non-significant results should be interpreted with caution rather than as definitive evidence of no difference. Some items were also single-item and broadly phrased, which may have allowed heterogeneity in interpretation across respondents and should be considered when interpreting these findings. The absence of qualitative data also limits the depth of insight into the motivations and contextual factors underlying participants’ responses. Finally, as the survey was conducted in a hypothetical context, prior to the implementation of any population-based screening programme, perceptions may evolve once real-world experience is gained. Although deliberate efforts were made to formulate questionnaire items as neutrally as possible, responses remain subject to interpretation, as is inherent to survey-based research.

Future perspectives

While public attitudes toward screening have already been studied in Flanders, this study addresses a notable gap in understanding HCPs’ perspectives. These insights are essential for tailoring implementation strategies to the local healthcare context and for identifying the practical supports required to ensure successful uptake. Future research should complement these findings with qualitative studies exploring context-specific barriers and enablers. Longitudinal studies may help track how and behaviours evolve as pilot programmes are implemented. Importantly, the findings indicate a high level of support among HCPs for the introduction of population-based lung cancer screening, alongside a strong willingness to refer eligible patients. Future studies should therefore explore how this motivation can be translated into sustained engagement in clinical practice, and how interprofessional collaboration between general practitioners, pharmacists, tobacco specialists, and medical specialists can best be structured. Policy initiatives should focus on multidisciplinary coordination, clear clinical guidelines, and adequate resource allocation, including training and reimbursement, to facilitate effective implementation and ensure equitable access for all eligible individuals.

Conclusion

This study demonstrates that HCPs in Flanders generally support the introduction of a population-based lung cancer screening programme and recognise its potential to improve early detection and survival outcomes. General practitioners expressed a more cautious, possibly pragmatic stance, while other professionals expressed a high willingness to support eligible individuals in considering participation in a future lung cancer screening programme, highlighting the value of interprofessional collaboration. Key barriers included limited time, insufficient training, and a lack of staff or technical resources. Addressing these challenges through targeted professional education, integration of screening workflows into existing health information systems, and stronger coordination between care levels will be crucial to ensure effective and successful implementation.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

HCP

Healthcare professional

HCPs

Healthcare professionals

IQR

Interquartile range

LDCT

Low—dose computed tomography

LCS

Lung cancer screening

MILD

Multicentric Italian lung detection study

NLST

National lung screening trial

NELSON

NEderlands—Leuvens Longkanker Screening Onderzoek

SDM

Shared decision—making

Author contributions

Conceptualisation, L.M., G.V.H., C.D., and I.H.; methodology, L.M., G.V.H., C.D., and I.H.; validation, G.V.H., C.D., and I.H.; formal analysis, L.M., and C.V.; investigation, L.M., and C.V.; resources, L.M.; data curation, L.M., writing—original draft preparation, L.M; writing—review and editing, L.M., G.V.H., C.D., and I.H.; visualisation, L.M.; supervision, G.V.H., C.D., and I.H.; project administration, I.H.; funding acquisition, G.V.H., and I.H. All authors have read and agreed to the published version of the manuscript.

Funding

This research was supported by external funding from Kom op Tegen Kanker, a Belgian non-profit cancer foundation.

Data availability

All data generated or analysed during this study are included in this published article and its supplementary information files.

Declarations

Ethics approval and consent to participate

Ethical approval for this study was obtained from the Ethics Committee Research of University Hospitals Leuven (UZ Leuven) and KU Leuven, Belgium (S69748). The committee confirmed that the study did not fall under the scope of the Belgian Law of 7 May 2004 on experiments on the human person, as it involved an anonymous, non-interventional survey among HCPs. Because the survey was fully anonymous and voluntary, written informed consent was not required; completion of the questionnaire was considered to imply consent. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.