Recruitment Strategies for Lung Cancer Screening: An Umbrella Review Protocol.

Background: Lung cancer is the leading cause of cancer-related mortality worldwide. Low-dose CT (LDCT) lung cancer screening (LCS) reduces lung cancer-specific mortality by 20%, yet participation remains low, often below 15%, compared with 60-75% for other cancer screening programmes. Barriers such as limited accessibility, stigma, fear of diagnosis, and misconceptions contribute to poor uptake, particularly among high-risk groups, including heavy smokers, ethnic minorities, and individuals from lower socioeconomic backgrounds. Various recruitment strategies-such as personalised invitations, media campaigns, and primary care referrals-have been implemented, but their effectiveness across different populations remains unclear. This umbrella review will synthesise evidence from systematic reviews to identify the most effective recruitment strategies for improving LCS participation.

Methods: This umbrella review will follow Joanna Briggs Institute guidelines and the PRIOR reporting framework. A systematic search of PubMed, Embase, Scopus, Web of Science, Cochrane Library, and systematic review registries will identify systematic reviews published before 31 October 2024. Eligible reviews must evaluate LCS recruitment strategies and report on at least one of the following: population reach, screening up take, adherence, patient experience, or implementation barriers. Quality will be assessed using AMSTAR 2, and overlapping primary studies will be mapped to prevent duplication. A narrative synthesis will categorise recruitment strategies, and a qualitative effectiveness ranking will summarise key findings.

Implications: Findings will inform LCS recruitment strategies in Europe, contributing to the EU4Health-funded EUCanScreen programme. This review will support efforts to improve uptake, reduce disparities, and enhance early detection and survival outcomes of lung cancer.