Implementation Determinants of Web-Based Decision Aids in European Population-Based Cancer Screening: Insights From EUCanScreen Consortium
Marcos Castejón, Marta Mascareñas, Gemma Binefa, Yelena Tarasenko, Melani Janjić, Barbara Fröschl, Apostolos Vantarakis, Cinzia Colombo, Montse GarciaPURPOSE
Decision aids (DAs) differ from standard information materials by addressing a specific decision, presenting all options with balanced evidence on benefits and harms, and incorporating values clarification methods to support informed choice. An updated Cochrane review (Stacey et al., 2024) provides moderate-certainty evidence of their effectiveness but highlights a persistent implementation gap across health systems. We explored implementation barriers and facilitators of self-determined web-based DAs in European population-based cancer screening.
METHODS
As part of the EUCanScreen Joint Action, a hybrid workshop (Bled, 2026) convened programme managers, clinicians, researchers, and policy-makers from across Europe. Participants responded via Slido to multiple-choice and open-text questions structured around CFIR 2.0 domains: Innovation, Inner Setting, Outer Setting, and Individuals domains. Open-text responses were analysed through directed content analysis. A follow-up survey assessed implementation stage, support needs, and unmet needs by cancer type.
RESULTS
The workshop engaged 107 participants (average 38 responses per question); 31 respondents from 16 countries completed the follow-up survey. Most workshop participants (64%) perceived web-based DAs as an improvement over current practice; only 6% considered them worse. However, implementation was rarely a programme priority. Key barriers included unclear responsibilities, high workloads, and uncertainty about hosting and management. IT integration emerged as both barrier and facilitator depending on capacity. Digital equity concerns arose around older and vulnerable populations. GDPR compliance and uncertainty about classification as medical devices were prominent. Facilitators included public health networks (65%) and supportive national policies. Two-thirds of participants relied on healthcare professionals for dissemination, although time constraints limited this approach. While 87% identified additional funding as necessary, 70% considered obtaining it feasible. Discussions and follow-up responses also revealed confusion between DAs and standard information materials.
CONCLUSION
Barriers to implemented web-based DA are not uniform across Europe and are likely amplified in settings with less developed digital infrastructure, more constrained resources, or less centralised health system governance. For screening programmes prioritising DA implementation, key aspects to address would be integrating the DA into the screening pathway, monitoring and equity. These insights initiate a multinational collaboration to develop adaptable implementation strategies for web-based DAs in cancer screening.