Barriers and facilitators to population-based lung cancer screening in Belgium: a qualitative stakeholder analysis in a pre-implementation context.

BACKGROUND: Low-dose computed tomography screening has demonstrated effectiveness in reducing lung cancer mortality among high-risk populations. Despite growing international momentum and supportive evidence, population-based lung cancer screening has not yet been implemented in Flanders, Belgium. Successful implementation requires insight into context-specific barriers and facilitators from both healthcare professionals (HCPs) and potential screening participants (PSPs). This study aimed to explore stakeholders' perspectives on the implementation and uptake of lung cancer screening in Flanders. METHODS: A qualitative exploratory study was conducted using semi-structured interviews with two stakeholder groups: HCPs involved in lung cancer prevention, detection, or care, and PSPs who would likely be eligible for lung cancer screening if such a programme were implemented. Interviews were conducted between October 2024 and February 2025 and analysed using the Qualitative Analysis Guide of Leuven (QuAGOL). Identified themes were subsequently organised according to the Consolidated Framework for Implementation Research (CFIR) domains and constructs. RESULTS: Interviews were conducted with 22 HCPs and 13 PSPs. Overall, attitudes towards lung cancer screening were positive, driven by perceived benefits of early detection and reassurance. Key barriers to implementation and participation included smoking-related stigma, limited health literacy, indirect financial and logistical constraints, competing life priorities, and fear or anxiety related to screening and waiting for results. HCPs additionally highlighted concerns regarding workload, limited capacity, and the need for professional training and coordinated communication pathways. Important facilitators included clear and standardised screening guidelines, governmental coordination and funding, integration within existing healthcare workflows, accessible and flexible screening organisation, public awareness campaigns, and timely, transparent communication. Across stakeholder groups, trust-based, non-judgemental communication and endorsement by trusted HCPs were considered essential to support equitable participation and sustained engagement. CONCLUSIONS: Stakeholders in Flanders are broadly supportive of population-based lung cancer screening, but successful implementation will depend on addressing organisational complexity, stigma, equity, and accessibility. Beyond clinical efficacy, careful programme design, interprofessional collaboration, and person-centred communication will be key to equitable and sustainable uptake. These findings offer actionable guidance for policymakers and may inform implementation in comparable healthcare settings and systems. CLINICAL TRIAL NUMBER: Not applicable.