Healthcare professionals’ perceived barriers and facilitators of risk-stratified follow-up care in lung cancer: a qualitative study

PURPOSE: Routine follow-up of lung cancer patients involves thoracic computed tomography (CT) scans every 3-6 months for 2 years and then annually up to 5 years. With increasing numbers of survivors, risk-stratified follow-up, tailoring surveillance to recurrence risk, may reduce unnecessary scans while maintaining high-quality follow-up. This study explored healthcare professionals' (HCPs) perceived barriers and facilitators to implement risk-stratified follow-up in lung cancer care. METHODS: A qualitative study was performed, involving 14 semi-structured individual interviews with HCPs engaged in lung cancer care. Transcripts were analyzed using inductive thematic analysis, with codes subsequently organized according to the Grol and Wensing framework across six different levels: Innovation, Patient, Professional, Social context, Organization, and Economic and Political. RESULTS: Barriers and facilitators were identified across all levels. HCPs generally viewed risk-stratified follow-up as a promising approach to align care with individual patient risk. Facilitators included its personalized nature, potential to reduce unnecessary imaging, and improve follow-up efficiency. However, HCPs emphasized the need for robust evidence demonstrating safety, effectiveness, and resource optimization. Patient-level barriers included varying follow-up preferences and limited health literacy, while tailored communication was seen as a facilitator. Organizational barriers such as staffing shortages and unclear role delineation were frequently mentioned. Integration into care pathways and interprofessional collaboration were identified as facilitators to address these challenges. Concerns about reduced clinical autonomy and patient safety were also expressed. Financial constraints at the economic and political level were reported to potentially hinder implementation. CONCLUSION: HCPs are generally receptive to evidence-based risk-stratified follow-up. Successful implementation requires evidence of effectiveness, integration into care pathways, clear roles, and aligned reimbursement.