| System building blocks |
Governance |
-
•
Clear definition of roles between national, regional or local levels in terms of decision-making, organization, and deployment of screening, with centralized monitoring of data and a national protocol guiding all implementation
-
•
Opportunities for the involvement of relevant professional societies and patient organizations in decision-making on lung cancer screening
|
| Information |
-
•
Comprehensive data management system, covering all aspects of the program
-
•
Full interoperability between screening program and health data systems to capture outcomes for all screening attendees and ensure regular updating of invitation database
-
•
Widespread information campaign conveying appropriate, accessible information about screening through all possible channels
|
| Health workforce |
-
•
Comprehensive workforce planning to ensure sufficient personnel to perform scans and follow-up care
-
•
Training and accreditation criteria are defined for all imaging personnel and applied in all participating screening centers
-
•
Full engagement of primary care physicians, with appropriate training in place
|
| Medical technologies |
-
•
Quality criteria for CT scans and low-dose specifications consistent across all screening centers
-
•
Identification of the best software to perform a volumetric assessment of nodules
-
•
Use of AI to aid interpretation of scans
|
| Service delivery |
-
•
Screening program fully integrated into multidisciplinary care pathways
-
•
Preemptive addressing of any deficits along the lung cancer pathway that may result in delays in diagnosis and access to care
-
•
Full integration of lung cancer screening program with an existing smoking cessation program
|
| System goals |
Access, coverage, equity, and responsiveness |
-
•
Optimal selection criteria for screening are defined, to ensure broad outreach to the population at the highest risk of lung cancer, and built into the invitation database
-
•
The selection of organization model (centralized vs. decentralized) balances the need for consistent quality with ease of access to the population
-
•
Shared decision-making is built into screening protocol to ensure participants are fully informed of the risks and benefits of screening
-
•
Targeted outreach and careful messaging to address known barriers to attendance in vulnerable groups, including fears of diagnosis, and stigma surrounding smoking
|
| Quality and safety |
-
•
Systematic quality assurance is built into all screening centers, regardless of location, and quality assurance metrics established from outset of the program
-
•
A consistent definition of ‘low dose’ adopted across all screening centers
|
| Efficiency |
-
•
Centralized coordination of the program, building economies of scale with other screening programs, as appropriate
-
•
Exploration of individualized screening protocols on the basis of biomarkers or other factors to minimize false positives, unnecessary scans, and exploratory procedures (also relevant to “Quality and safety”)
|
| Population health |
-
•
Monitoring of lung cancer cases detected by the program, and outside of it, stratified by socioeconomic, and demographic data
-
•
Monitoring of impact on stage distribution and lung cancer mortality through appropriate data linkages to cancer registry
|
