Access the latest evidence detailing the common reasons for non-attendance and develop strategies to re-engage participants. Learn how to manage patients exiting the programme whether this is due to patient choice, completion of eligibility, or medical advice.
Evidence shows:
- Groups of people least likely to attend: people who do not participate in lung cancer screening programmes are more likely to be female, be active smokers, have lower income, less education, poor health literacy, and no regular primary care provider. Perceived low personal risk, fear of results, competing priorities, and mistrust of the healthcare system are common reasons for opting out (Clinical Lung Cancer, 2020 and Family Practice, 2017).
- Practical and logistical barriers: transportation difficulties, long travel distances, inconvenient appointment times, and inflexible work schedules disproportionately affect socially disadvantaged and rural populations (Translational Lung Cancer Research, 2021).
- Dropout from ongoing programmes: even when people start screening, some fail to return for follow-up scans. Key factors for dropout included current smoking, low socio-economic status, and a lack of understanding about the importance of continued participation (International Journal of Oncology, 2014).
- Smoking cessation integration can help: offering cessation services alongside screening can improve engagement and reattendance. In the Yorkshire Lung Screening Trial, an opt-out, co-located cessation service achieved high uptake and promising quit rates (European Respiratory Journal, 2024). Long-term follow-up studies show integrated cessation can improve retention over multiple years (Clinical and Research Reports, 2021).
- System-level solutions: the ESR/ERS statement recommends personalised invitation methods, culturally appropriate messaging, and community outreach to improve participation, especially in underserved groups (European Radiology, 2020).
- Impact of low compliance: when participation in programmes is low, the number of lives saved from screening is substantially reduced. High compliance rates are essential to realise the mortality benefits demonstrated in clinical trials (Cancer Causes Control, 2018).
Case studies: