Qualitative Insights From Public Interviews in the United Kingdom on the Acceptability of Risk‐Based Eligibility Criteria for Lung Cancer Screening

BACKGROUND: Targeted lung cancer screening programmes in the United Kingdom use multivariable risk models to identify high-risk individuals. However, public acceptability of targeting screening by risk using eligibility criteria, such as age and smoking history, remains unclear, including the psychological and behavioural consequences of eligibility disclosure. AIM: To explore UK public attitudes toward the acceptability of current risk-based eligibility criteria for lung cancer screening and the anticipated psychological and behavioural responses to eligibility disclosure. METHODS: A qualitative study was conducted as the second phase of a sequential explanatory design. Semi-structured telephone interviews were held with 28 UK adults aged 45-77 years between January-April 2024. Participants were purposively sampled for diversity in demographics, smoking history, and prior acceptability questionnaire responses. Interviews were analysed using applied thematic analysis informed by the Theoretical Framework of Acceptability. RESULTS: Criteria were generally acceptable when perceived as evidence-based and logical, particularly age and smoking history. However, participants expected flexibility, suggested expanding inclusion criteria and had concerns about fairness and discrimination especially regarding ethnicity and education. Eligibility was anticipated to motivate screening attendance but also cause worry; the prospect of ineligibility often led to feelings of exclusion, anxiety, and disappointment. Participants emphasised the need for clear, evidence-based communication of the rationale and individual risk, alongside alternative options or support for those who are ineligible. CONCLUSIONS: Clear and transparent communication of the rationales underpinning eligibility criteria, provided by the screening programme and trusted health professionals, are essential for improving public acceptability and individual understanding of eligibility status. These strategies should also mitigate against potential stigma, perceived discrimination, and over-reassurance, while ensuring appropriate safety-netting and risk management for those who are ineligible. Tailored messaging and pathways may optimise engagement, trust, and psychological wellbeing within lung cancer screening programmes. PATIENT OR PUBLIC CONTRIBUTION: The research team sought the views of eight public and patient representatives with lung cancer experience (either personally or being a carer) during study conception. They endorsed the research objectives, helped to develop participant-facing interview questions and gave feedback on the appropriateness of the design, agreeing that in-depth interviews would best capture perceptions of the acceptability of risk-based eligibility criteria.