提高肺癌筛查项目参与度的干预措施：系统综述与荟萃分析。
完整摘要 · 中文译文
引言：我们旨在系统综述和荟萃分析基于低剂量计算机断层扫描（LDCT）的干预措施在提高肺癌筛查中知情选择和参与度方面的有效性。 方法：检索了五个电子数据库，Medline（PubMed版本）、Embase、Cinahl（Ebsco版本）、Scopus和Cochrane CENTRAL，纳入2000年至2023年3月15日发表的随机对照试验、非随机对照试验和前后对照研究。采用随机效应荟萃分析评估干预措施提高LDCT完成率的效果。 结果：在共检索到的3483项研究中，14项已完成研究和21项正在进行的研究被纳入本综述。与对照组相比，共享决策（SDM）+导航（OR 4.34，95% CI 2.50-7.54）和外展服务+导航（OR 2.20，95% CI 1.70-2.84）使LDCT实施比例更高。教育/信息类干预（OR 1.03，95% CI 0.89-1.19）以及单独SDM（OR 1.15，95% CI 0.57-2.32）未能提高LDCT接受率，尽管后者改善了干预组和对照组的决策结局。多组分干预显示LDCT接受率显著更高（OR 2.64，95% CI 1.79-3.90），相比之下单组分干预为（OR 1.00，95% CI 0.87-1.14）。绝大多数干预措施，包括正在进行试验中的干预措施，均以患者为导向，而基于社区的、提供者层面和系统层面的干预措施仍然少见。 结论：结合高强度以患者为导向的干预措施，如患者导航，ac 积极的 outreach 和 SDM 似乎是提高肺癌筛查接受率最有前景的策略（证据确定性低）。然而，需要实施研究来评估针对提供者和医疗保健系统层面的干预措施。
完整摘要 · 英文原文
INTRODUCTION: We aimed to systematically review and meta-analyse the effectiveness of interventions in increasing informed choice and participation in lung cancer screening based on low-dose computed tomography (LDCT). METHODS: Five electronic databases, Medline (PubMed version), Embase, Cinahl (Ebsco version), Scopus and Cochrane CENTRAL, were searched for randomised controlled trials, nonrandomised controlled trials and before-after studies published from 2000 until 15 March 2023. A random-effects meta-analysis was conducted to assess the effectiveness of interventions to increase rates of LDCT completion. RESULTS: Out of 3483 studies identified, 14 completed and 21 ongoing studies were included in the review. Shared-decision making (SDM)+navigation (OR 4.34, 95% CI 2.50-7.54) and outreach+navigation (OR 2.20, 95% CI 1.70-2.84) resulted in a higher proportion of LDCT performed compared to the control group. Educational/informational interventions (OR 1.03, 95% CI 0.89-1.19) as well as SDM alone (OR 1.15, 95% CI 0.57-2.32) did not improve LDCT uptake, despite the second improving decisional outcomes in both intervention and control groups. Multicomponent interventions showed significantly higher LDCT uptake (OR 2.64, 95% CI 1.79-3.90), compared to unicomponent interventions (OR 1.00, 95% CI 0.87-1.14). The vast majority of interventions, including those in ongoing trials, are patient-oriented, while community-based, provider-level and system-level interventions remain rare. CONCLUSIONS: Combining high-intensity patient-oriented interventions, such as patient navigation, active outreach and SDM, appears to be the most promising strategy to increase lung cancer screening uptake (low certainty of evidence). However, implementation studies are needed to evaluate interventions targeting both provider and healthcare systems level.