Background: Lung cancer screening offers mortality benefit in trial settings, yet its population impact depends on communication that supports informed choice while mitigating predictable harms, including false positives, incidental findings, radiation exposure and overdiagnosis. Communication is further complicated by stigma related to smoking, fear and fatalism, knowledge avoidance, variable health literacy and the risk of widening inequalities in a small multilingual and culturally diverse country.

Objectives: To synthesise international evidence on communication for lung cancer screening and to translate this evidence into a preliminary, practical communication framework to inform the design and implementation of lung cancer screening in Luxembourg as part of SG Reform funded LLUMINAS project.
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Methods: We conducted a pragmatic targeted rapid evidence review. Iterative searches combined terms related to lung cancer screening, communication, decision aids, digital interventions, stigma, equity and behavioural insights, supplemented by reference list screening and citation tracking. We purposively included qualitative and quantitative studies of public and professional perspectives, intervention evaluations and existing tools (for example, invitation materials, decision aids and results communication resources), alongside scoping and systematic reviews. Data were extracted into a structured evidence table and synthesised thematically, organised along the screening pathway from programme set up and invitation through decision making, encounter communication, results and follow up, and ongoing engagement across repeat rounds.

Results: Evidence indicates that communication quality is inseparable from programme design. Studies consistently emphasise the need for clear roles, centralised and reliable referral and follow up pathways, and supportive information systems, because these features determine whether communication is timely, consistent and trustworthy. Invitations are received within a context of ambivalence and distress. Common barriers include knowledge avoidance, perceived low value in the absence of symptoms, worries about false positives, practical constraints and misunderstandings about the purpose and consequences of screening. Promising approaches include positive and non judgemental language, simple culturally appropriate, and equity oriented outreach that does not rely on prior engagement with health services. Decision aids and written or digital tools generally improve knowledge and decision quality, particularly understanding of harms, but evidence of sustained effects on uptake and equity remains limited, reinforcing the ethical priority of informed, value consistent decisions. Result communication emerges as a high sensitivity stage; participants value layered explanations of result categories and next steps, paired with timely follow up contact and formats accessible beyond high literacy groups. Drawing on this synthesis, we propose an “engaged approach” framework structured around respect, trust and sustained engagement, supported by behavioural adherence elements and routine communication audit to detect and reduce iatrogenic stigma.

Conclusions: This rapid review provides an evidence informed foundation for a Luxembourg specific communication framework for lung cancer screening. It will form the basis of stakeholder discussion, and, coupled with stakeholder recommendations, will guide co-development of multilingual, equity oriented communication materials, provider supports and programme communication processes for early implementation and evaluation in Luxembourg. 
 

Lung cancer screening communication: Key evidence across the pathway