Table 5.
Evidence table summarizing implementation facilitators and barriers at the patient level
| Citation | Target population | Facilitators | Barriers |
|---|---|---|---|
| Carter-Harris and Gould (27) | Patients aged 55 to 77 years within primary care clinics in Washington state | None provided | Practical barriers represented time and logistical issues related to the inconvenience associated with the screening location (patient needs and resources); knowledge avoidance—fear of the disease and treatment and perceived low value—wasted effort and skepticism (knowledge and beliefs) |
| Cataldo (28) | US current and former smokers aged older than 55 years | Perceive accuracy of the LDCT as an important factor in the decision to have a LDCT scan, believe that early detection will result in a good prognosis, believe that they are at high risk for lung cancer; are not afraid of CT scans (knowledge and beliefs) | None provided |
| Draucker et al. (30) | Long-term current and former smokers in the United States, eligible for LCS per USPSTF guidelines | Screening covered by their insurance as a preventative tool (patient needs and resources); required by Medicaid or was part of a research study (external policy and incentives); valuing early detection (knowledge and beliefs); family history of lung cancer, receiving a recommendation from a physician (engaging; external change agents and champions) | Cost of the scan, no time to get screened (patient needs and resources); felt it was unnecessary, knew little about LDCT (knowledge and beliefs); physician who was not supportive of screening and/or recommended against it, physician did not mention it (engaging) |
| Duong et al. (32) | Patients referred for LDCT screening through Stanford’s Lung Cancer Screening Program | Have insurance (patient needs and resources); worried about their health, believe screening is useful and accurate (knowledge and beliefs); former smoker (individual stage of change); trust in provider(s) (individual identification with organization) | None provided |
| Hall et al. (35) | Participants undergoing a LDCT scan | Medicare insurance (external policy and incentives); patients understood the reason for their screening referral and perceived LDCT to be moderately accurate (knowledge and beliefs); having higher education levels (other personal attributes) | None provided |
| Kanodra et al. (40) | Veterans meeting USPSTF criteria for LCS who had been offered LDCT screening by their PCPs | Identified smoking as a risk factor, identified previous inhalational exposures as increasing their risk of lung cancer (knowledge and beliefs); trusting relationship with PCP (individual identification with organization); found the conversation with the screening coordinator, brochures, posters, or videos in the waiting room helpful (engaging; formally appointed internal implementation leaders) | Screening isn’t convenient (patient needs and resources); did not think they were at risk of disease, perceived their own health to be good, very good, or excellent compared with their age cohort, test accuracy concerns (knowledge and beliefs); PCP did not discuss LDCT screening with them, did not read brochure when it was mailed to them (engaging) |
| Li et al. (44) | Aged 55 years and older current or former smoker Chinese Americans (can read and write in Chinese) living in the greater Chicago Metropolitan area | Program that provides transportation to clinics and covers cost of screening (patient needs and resources); adequate knowledge about the screening procedure (knowledge and beliefs); high levels of trust in their physicians (individual identification with organization); providing older adults with adequate information about the screening procedure, physician recommendation, patient navigator, or some other type of assistance (engaging; formally appointed internal implementation leaders and champions) | Lack of insurance, out-of-pocket costs, lack of transportation, entire health care process—due to language barriers difficult to navigate (patient needs and resources); poor English language (other personal attributes); lack of specific lung cancer symptoms, perceived lack of provider time to discuss screening during appointment (knowledge and beliefs) |
| Lillie et al. 2017 (45) | Patients meeting the USPSTF LCS criteria at the time of an appointment with their PCP at Minneapolis VA Health Care System | Viewed LCS as convenient (design quality and packaging); fear of getting lung cancer, LCS knowledge (knowledge and beliefs) | Anxiety waiting for results, fear of incidental findings (knowledge and beliefs) |
| Mishra et al. (47) | Patients who were receiving care at an FQHC Clinic in Albuquerque, New Mexico, or the University of New Mexico Comprehensive Cancer Center | Concern for one’s personal health—knowing consequences of long-term tobacco use (knowledge and beliefs); doctor referral (engaging; champions) | Lack of transportation, cost of purchasing insurance, low health literacy, distance to care, cost of treatment (patient needs and resources); uncertainty about the value of screening (in terms of the benefits and necessity) and logistics of the screening procedure, fear of radiation exposure, concerns about psychological distress (knowledge and beliefs); the challenge of being able to trust health-care providers (individual identification with organization) |
| Monu et al. (48) | Registered participants in the Amazon MTurk crowdsourcing marketplace living in the United State, at high risk for lung cancer who met the USPSTF eligibility criteria for screening | Efficacy of early detection, knowledge of a screening test, believe they were at high risk for lung cancer (knowledge and beliefs); former smoker (individual stage of change); if recommended by their physician (engaging) | Did not think a screening test exists (knowledge and beliefs); current smoker (individual stage of change) |
| Raz et al. (52) | Current smokers who were enrolled in a tobacco cessation program at Kaiser Permanente medical centers in Southern California | Patient perceptions that LCS decreases worry for patients and families, gives peace of mind, and helps future planning (knowledge and beliefs) | High cost of test (patient needs and resources); worrying about being blamed for having smoked, worrying about feeling like a social outcast for smoking (knowledge and beliefs); current smoker (individual stage of change); no family history of lung cancer (engaging; external change agents) |
| Roth et al. (53) | Members of Kaiser Permanente, Washington, who met USPSTF screening criteria | Low or limited harm from LDCT scan perception, benefit of early detection of lung cancer (knowledge and beliefs); trust in providers (individual identification with organization); experiences of friends or family with advanced cancer (engaging; external change agents) | None provided |
| Simmons et al. (54) | Community members in Florida who met the USPSTF LCS screening criteria and had not undergone LDCT screening for lung cancer | Believes screening is beneficial, values early detection (knowledge and beliefs); informational and discussions and shared decision making (engaging) | Cost, inconvenient (patient needs and resources); confusion and misunderstanding of screening, concerns related to accuracy of the screening test (knowledge and beliefs); not brought up by provider (engaging; champions) |
| Sin et al. (55) | Korean men in Washington who were immigrants to the United States and who met the USPSTF eligibility criteria for screening | Interest in health, perceptions about the importance of seeking preventive health care in relation to the consequences of aging, perceptions concerning positive aspects of the health-care system in South Korea (knowledge and beliefs); doctor referral, recommendations from others—family members and the Korean Women’s Association (engaging; champions and external change agents) | Costs of health care in the United States, lack of time—competing demands (patient needs and resources); lack of knowledge about lung cancer, attitudes about prevention (knowledge and beliefs); lack of physician recommendation (engaging; champions) |
| Tseng et al. (56) | African American smokers aged 55-77 years who have had either 30 or more pack-years of smoking or had received an LDCT exam in the past year | Believes screening is beneficial, values early detection, concern about lung health (knowledge and beliefs); doctoral referral (engaging; champions) | Screening cost (patient needs and resources); moderate to low knowledge regarding LDCT screening (knowledge and beliefs). |
| Williams et al. (57) | African Americans who met the USPSTF eligibility criteria for LDCT screening | Felt they had all the information they needed to make an informed decision (knowledge and beliefs) | Had not heard of LDCT, uncertain of their decision to be screened (knowledge and beliefs) |
FQHC = federally qualified health centers; LCS = lung cancer screening; LDCT = low-dose chest computed tomography; PCP = primary care provider; VA = Veterans Affairs; USPSTF = US Preventive Services Task Force.