Multilevel barriers to the successful implementation of lung cancer screening: Why does it have to be so hard?

The U.S. Preventive Services Task Force recommends lung cancer screening with low-dose computed tomography for long-termcurrent and former smokers. However, lung cancer screening and its implementation are a complex issue. Screening has associated risks and potential harms that complicate the decision to screen for the patient, add to the already time-constrained clinical encounter for the provider, and present logistical and sociopolitical challenges in creating and implementing lung cancer screening programs in the health care system. As lung cancer screening is more widely implemented in the United States, it is critical for those in the health care system to be cognizant of potential barriers to effective screening implementation at the patient, provider, and system levels when designing effective support interventions, as well as to proactively address potential impediments to this new screening option. This paper presents perspectives on these multilevel barriers to lung cancer screening.