US healthcare staff identify multilevel barriers to equitable lung cancer screening

Researchers conducted virtual, semi-structured interviews with 15 US non-physician healthcare staff, including nurses and medical assistants working in settings that offered lung cancer screening. Interviews averaged 44 minutes and were analyzed using a framework focused on health equity and implementation barriers across patient, provider, clinical encounter and healthcare-system levels.

Participants identified limited patient and provider awareness of screening, little staff clinical knowledge, insufficient provider time for screening discussions, patient concerns such as claustrophobia, and limited transportation. They also cited cost concerns, healthcare mistrust, smoking-related stigma, provider bias or discrimination, inadequate media coverage and societal disregard for older and under-resourced populations. Staff described these barriers as interconnected and operating across multiple levels.

The findings provide staff perspectives that may inform the design of multilevel approaches to improve equitable screening access. They do not test interventions or establish which barriers most affect screening uptake. The small qualitative sample captures reported perceptions rather than measuring prevalence or causal effects; findings may not represent all screening settings or staff roles.