Lung cancer screening knowledge, opinions and attitudes among healthcare professionals in Estonia prior to national program initiation

Background: This study aimed to gain insight into the opinions and attitudes about, and potential barriers and facilitators to lung cancer screening (LCS) among healthcare professionals in Estonia. It also aimed to determine knowledge gaps that could be addressed when planning next steps toward a national LCS program. Methods: A cross-sectional, web-based survey was conducted in June to August 2023 among primary care providers (PCPs), pulmonologists, radiologists, oncologists, and thoracic surgeons in Estonia. Differences between PCPs and other specialists were analyzed with regard to their knowledge, beliefs and attitudes toward LCS. Results: About 146 healthcare professionals responded, 57% were family physicians. Less than half of all respondents considered existing evidence or international recommendations sufficient to support national LCS implementation, with uncertainty higher among PCPs. Adjusted analyses revealed that the PCPs had substantially higher odds of responding "Do not know" concerning international recommendations (aOR 5.06; 95% CI 1.97-13.85), and were far less likely to agree to assigning main responsibility for LCS participation to family physicians (aOR 0.10; 95% CI 0.02-0.40). PCPs also demonstrated greater uncertainty about the costs and labor intensity in LCS. Conclusion: This study reveals substantial variation in LCS knowledge, attitudes, and certainty across healthcare profession(al)s, highlighting the need for targeted training. Although for most professionals the benefits of LCS outweigh potential harms, structural constraints and uncertainty should still be carefully considered. Despite limited generalizability, study findings support evidence-informed planning and have already been considered in the Estonian LCS pilot study, the first step toward a national LCS program.