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About the implementation toolkit
The Network has developed this implementation toolkit to support those involved in the planning and delivery of lung cancer screening programmes around the world. It is designed to encourage those applying the Network’s framework to take a health systems readiness approach, recognising that whilst not all health systems will be fully ‘ready’ for lung cancer screening implementation, this should not delay planning and implementation.
Within this toolkit, you can find out more about using the Network’s implementation framework, and the six domains that it is divided into. You can also access a suite of supporting materials by exploring the individual domain pages and the resources library.
As the implementation of targeted LDCT screening programmes gains pace, it is essential to optimise these programmes to ensure that they have an impact on population health. We hope this toolkit will help ensure that implementation is both feasible and geared for success.
Framework domains
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Domain 1: Governance
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Domain 2: Workforce and technical capacity
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Domain 3: Financial planning
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Domain 4: Eligibility and recruitment
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Domain 5: LDCT screening delivery
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Domain 6: Data monitoring and evaluation
Domain 1: Governance
Domain 1: Governance
Domain 1 serves as the starting point for those looking to implement a lung cancer screening programme. It supports the evaluation of governing policy context, stakeholder engagement, and programme governance and coordination. The successful implementation of a screening programme is reliant on a solid understanding of the existing policies and guidelines on cancer management and a clear strategy around responsibility for each stage of the process.
Click here to download a policy brief focused on governance.
Domain 2: Workforce and technical capacity
Domain 2: Workforce and technical capacity
Domain 2 requires users to look closely at the professionals involved in delivering a lung cancer screening programme. It helps them consider the current workforce and technical capacity to support the implementation of this programme. They can then determine whether additional staff, equipment or technical innovations are necessary.
Click here to download a policy brief focused on workforce and technical capacity.
Domain 3: Financial planning
Domain 3: Financial planning
Domain 3 helps with the development of a comprehensive budget, considering the anticipated costs of screening implementation and the options for financing the programme. Those responsible for implementation will also need to consider whether any associated costs will be covered for participants, particularly those who risk exclusion due to facing barriers to healthcare access.
Click here to download a policy brief focused on financial planning.
Domain 4: Eligibility and recruitment
Domain 4: Eligibility and recruitment
Domain 4 moves on to consider who will be eligible to participate in the screening programme once it has been implemented. Alongside defining the eligibility criteria and the recruitment process, those implementing the programme will need to think about how to engage the target population and ensure that these individuals have enough information to make an informed decision on taking part.
Click here to download a policy brief focused on eligibility and recruitment.
Domain 5: LDCT screening delivery
Domain 5: LDCT screening delivery
Domain 5 covers the delivery of LDCT screening, supporting the assessment of appropriate screening protocols and parameters to ensure quality and safety. As part of this assessment, those implementing the screening programme should consider how it can combine with other interventions, such as smoking cessation, and how it can be integrated into other aspects of care.
Click here to download a policy brief focused on developing a clear protocol for LDCT screening.
Domain 6: Data monitoring and evaluation
Domain 6: Data monitoring and evaluation
Domain 6 aims to help users determine what data they need to support implementation, as well as how to collect, standardise, share and use them. Users will also find this domain useful in establishing benchmarks against which to evaluate the impact of the programme on population health.
Download our framework to support the implementation of LDCT lung cancer screening
Download
Why is investment for LDCT screening needed?
Lung cancer is the most common cause of cancer deaths around the world, but increasing early detection could significantly change this.
Targeted LDCT screening is an effective and safe screening tool that can reduce mortality from lung cancer by up to one quarter in high-risk individuals.1-4 It can deliver a significant stage shift to earlier diagnosis in lung cancer among people who currently smoke or used to smoke. 1 5-7
When optimised, LDCT screening does not lead to a high proportion of false-positive results or subsequent unnecessary procedures or treatments.8 9
What does health system readiness for a lung cancer screening programme look like?
System readiness refers to the ability of a health system to rapidly and sustainably adapt policies, processes and infrastructure to support the integration of new components of care.
Some countries will have certain components in place with others still in development. Other countries will have regions that are more ready than others, calling for a stepwise roll-out over time. In all scenarios, adopting a systems approach to assessing readiness can help ensure that implementation is successful.
Learn more about the framework
The framework was developed based on a review of existing literature, expert interviews and insights from Network members. It was refined through application to five countries where implementation has already taken place: Canada, Poland, South Korea, the UK and the US.
The framework is organised into six domains, each consisting of a series of metrics. The metrics help assess whether key requirements for screening are in place and identify gaps that may need addressing.
Technical guidance and other resources are provided throughout the framework itself and across this online toolkit.
Implementation toolkit guide
This toolkit summary has been developed to support users in applying the implementation framework in their regional context.
The implementation toolkit contains many resources including case studies, templates and summary resources aligned to each domain of the implementation framework and this resource summarises what is available for teams.
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References
de Koning HJ, van der Aalst CM, de Jong PA, et al. 2020. Reduced lung-cancer mortality with volume CT screening in a randomized trial. New England Journal of Medicine 382(6): 503-13
Aberle DR, Adams AM, Berg CD, et al. 2011. Reduced lung-cancer mortality with low-dose computed tomographic screening. New England Journal of Medicine 365(5): 395-409
Field JK, Vulkan D, Davies MPA, et al. 2021. Lung cancer mortality reduction by LDCT screening: UKLS randomised trial results and international meta-analysis. The Lancet Regional Health – Europe 10(100179): 1-11
Bonney A, Malouf R, Marchal C, et al. 2022. Impact of low-dose computed tomography (LDCT) screening on lung cancer-related mortality. Cochrane Database Syst Rev 8(8): Cd013829
Becker N, Motsch E, Trotter A, et al. 2020. Lung cancer mortality reduction by LDCT screening-Results from the randomized German LUSI trial. International journal of cancer 146(6): 1503-13
Pastorino U, Silva M, Sestini S, et al. 2019. Prolonged lung cancer screening reduced 10-year mortality in the MILD trial: new confirmation of lung cancer screening efficacy. Annals of Oncology 30(7): 1162-69
Darrason M, Grolleau E, De Bermont J, et al. 2021. UKLS trial: looking beyond negative results. The Lancet Regional Health – Europe: https://doi.org/10.1016/j.lanepe.2021.100184: 100184
de Koning HJ, van der Aalst CM. 2020. NELSON trial: the authors reply. New England Journal of Medicine 382(22): 2164-66
Sands J, Tammemägi MC, Couraud S, et al. 2021. Lung screening benefits and challenges: a review of the data and outline for implementation. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 16(1): 37-53