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Systematic review and meta-analysis of nurse-led shared decision-making for lung cancer screening uptakeNurse-led conversations may help high-risk lung cancer patients choose low-dose CT scans

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Key Takeaway
Consider nurse-led SDM feasible for screening uptake, though evidence does not support superiority over usual care due to bias.

This publication is a systematic review and meta-analysis examining nurse-led shared decision-making interventions within high-risk lung cancer populations. The review included 13 608 participants across various study designs to assess the impact on low-dose computed tomography (LDCT) uptake and related outcomes. Data sources were not reported in the summary provided by authors.

In single-arm studies, LDCT uptake was reported at 98% (95% CI 28% to 100%), while willingness to participate stood at 68% (95% CI 24% to 93%). Comparative studies showed no significant difference in LDCT uptake with a relative risk of 1.00 (95% CI 0.99 to 1.02) per study. Benign or low-risk findings accounted for 81% (95% CI 77% to 85%), and early-stage lung cancer diagnosis occurred in 2% (95% CI 1% to 3%) of cases overall. Female sex was positively associated with uptake (beta=0.54, p<0.001), whereas current tobacco use was negatively associated (beta=-0.37, p=0.033).

Authors note the predominance of single-arm studies, high heterogeneity, and moderate-to-serious risk of bias, including selection bias issues. These factors further limit causal inference regarding the intervention's superiority. The evidence suggests feasibility as an alternative service delivery model rather than proven superiority over usual care. Safety outcomes were not reported in the analysis provided by authors.

For people at high risk for lung cancer, deciding whether to get a low-dose CT scan can be hard. A large review looked at how nurse-led shared decision-making helps. This approach lets patients and nurses talk openly about the test, the risks, and the benefits together. It is different from just getting the usual care where a doctor might recommend the test without that extra conversation time.

The review looked at 13,608 participants. When nurses led these conversations, 68% of people said they were willing to participate in the screening. In studies comparing this approach to usual care, the rate of people getting the scan did not change significantly. However, among those who did get the scan, 81% of the results showed benign or low-risk findings. Only 2% of scans found early-stage lung cancer.

The study also found that women were more likely to take up the screening offer, while current smokers were less likely. The researchers noted that most of the data came from single-arm studies, which means we cannot be sure this method is better than usual care. There was a moderate-to-serious risk of bias in the data. This review suggests nurse-led talks are a feasible way to offer screening, but it does not prove they are superior to standard medical advice.

What this means for you:
Nurse-led talks increased willingness to participate in lung cancer screening among high-risk patients.

Study Details

Study typeMeta analysis
Sample sizen = 13
EvidenceLevel 1
PublishedApr 2026
View Original Abstract ↓
OBJECTIVES: To evaluate the effects of nurse-led shared decision-making (SDM) on lung cancer screening outcomes, including low-dose CT (LDCT) uptake, benign findings, early cancer detection and willingness to participate among high-risk populations. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Medline via OvidSP, Cochrane Central Register of Controlled Trials, EMBASE via OvidSP, Web of Science, Scopus, grey literature databases and clinical trial registries were searched from inception to March 2025. ELIGIBILITY CRITERIA: Studies evaluating nurse-led SDM interventions in high-risk lung cancer populations, reporting outcomes including LDCT uptake rates, screening results (Lung-RADS (Lung Imaging Reporting and Data System) classifications), early-stage cancer detection or willingness to participate. Randomised controlled trials, quasi-experimental studies and observational studies were included. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data and assessed risk of bias using the Risk of Bias in Non-randomised Studies of Interventions (for non-randomised studies) and Cochrane Risk of Bias 2.0 (for randomised controlled trials). Meta-analyses were conducted using random-effects models. Meta-regression explored sources of heterogeneity. RESULTS: 13 studies (n=13 608 participants) were included, comprising 10 single-arm studies and three comparative studies. In single-arm studies without control groups, nurse-led SDM programmes achieved a pooled LDCT uptake rate of 98% (95% CI 28% to 100%; I²=99%), and willingness to participate was 68% (95% CI 24% to 93%; I²=98%). In comparative studies, nurse-led SDM showed no significant difference in LDCT uptake compared with usual care (RR 1.00, 95% CI 0.99 to 1.02; I²=0%), suggesting non-inferiority rather than superiority. Among individuals who completed screening, 81% (95% CI 77% to 85%) had benign or low-risk findings (Lung-RADS I/II), and 2% (95% CI 1% to 3%) were diagnosed with early-stage lung cancer, rates consistent with benchmark screening trials. Meta-regression identified female sex as positively associated with uptake (β=0.54, p<0.001), while current tobacco use was negatively associated (β=-0.37, p=0.033). The risk of bias was moderate to serious across studies. CONCLUSIONS: Comparative evidence suggests that nurse-led SDM achieves equivalent LDCT uptake to standard care approaches, indicating feasibility as an alternative service delivery model. However, the predominance of single-arm studies, high heterogeneity and moderate-to-serious risk of bias limit causal inference. High uptake rates in single-arm studies likely reflect selection bias rather than intervention effectiveness. Current evidence supports the feasibility but not the superiority of nurse-led SDM. Well-designed randomised controlled trials are needed to establish comparative effectiveness and cost-effectiveness before recommending widespread integration of nurse-led SDM into lung cancer screening programmes. TRIAL REGISTRATION NUMBER: PROSPERO CRD420251033595. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1033595.
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