Lung Cancer Screening Adherence in Centralized vs Decentralized Screening Programs: A Meta-Analysis of US Cohort Studies Among Individuals With Negative Baseline Results.

research_question

Is participation in a centralized screening program associated with higher adherence rates compared with decentralized programs among individuals with negative baseline LCS results?

在基线肺癌筛查结果为阴性的个体中，参与集中式筛查计划是否与比分散式计划更高的依从率相关？

study_design_and_methods

Seven bibliographic databases were searched for cohort studies published following January 1, 2011, reporting adherence outcomes for centralized vs decentralized LCS (primary outcome).

检索了七个文献数据库，以寻找自2011年1月1日以来发表的队列研究，这些研究报告了集中式与分散式肺癌筛查(LCS)的依从性结果(主要结果)。

Quality appraisal followed the Newcastle-Ottawa Scale for appraising observational studies.

质量评估遵循了用于评估观察性研究的新堡-渥太华量表。

Random-effects meta-analysiswas used to pool studies.

使用随机效应元分析来合并研究。

Meta-regression examined patient- and institution-level characteristics associated with adherence in centralized programs.

元回归分析了与集中化项目中依从性相关的患者和机构层面特征。

Results

Twelve studies involving 17,195 patients with negative baseline results were included in this meta-analysis.

本荟萃分析纳入了12项研究，共涉及17,195名基线结果为阴性的患者。

The overall pooled adherence rate in centralized programs was 55% (95% CI, 42%-58%; 12 studies, 11,302 patients) with 10 to 18 months of follow-up.

在集中管理项目中，总体合并的依从率为55%（95%置信区间，42%-58%；12项研究，11,302名患者），随访时间为10至18个月。

Adherence was significantly higher in centralized compared with decentralized screening programs (68.9% vs 37.1%; P < .0001), with a pooled OR of 3.33 (95% CI, 1.92-5.78; 4 studies, 17,195 patients; moderate certainty).

集中式筛查计划的依从性显著高于分散式筛查计划（68.9%对比37.1%；P<.0001），汇总后的比值比为3.33（95%置信区间，1.92-5.78；4项研究，17,195名患者；中等确定性）。

Substantial heterogeneity was observed across the 4 studies in the pairwise meta-analysis(I2 = 98.3%; P < .0001).

在成对的荟萃分析中，4项研究观察到显著的异质性（I2=98.3%；P<.0001）。

The Egger regression test showed no significant funnel plot asymmetry (z = -0.374; P = .71), suggesting no evidence of publication bias.

Egger回归检验显示没有显著的漏斗图不对称性（z = -0.374; P = .71），表明没有证据表明存在出版偏倚。

No association was found between adherence in centralized LCS and Lung CT Screening Reporting & Data System category, follow-up duration, age, sex, race/ethnicity, smoking status, or institutional setting (P > .05; very low certainty).

在集中式肺癌筛查（LCS）的依从性与肺部CT筛查报告和数据系统分类、随访时间、年龄、性别、种族/民族、吸烟状况或机构设置之间未发现关联（P > .05；非常低的确定性）。

interpretation

Our results indicate that adherence to LCS remains low but is significantly higher in centralized screening programs compared with decentralized ones.

我们的研究结果表明，尽管对肺癌筛查(LCS)的依从性仍然很低，但与分散式筛查项目相比，集中式筛查项目的依从性显著更高。

Centralization may improve equity by addressing disparities associated with patient- and institution-level characteristics.

集中化可能通过解决与患者和机构层面特征相关的差异来提高公平性。

These study findings support the expansion of centralized approaches and targeted quality improvement efforts to strengthen adherence to guideline-recommended LCS.

这些研究结果支持扩大集中化方法和针对性的质量改进措施，以加强遵循指南推荐的肺癌筛查(LCS)的依从性。