Exploring Barriers and Facilitators to the Buy-In of Multi-Cancer Early Detection Tests

Multi-cancer early detection (MCED) tests are a novel approach to cancer screening, offering potential to detect multiple cancers through a single blood draw. This study explored the barriers and facilitators to buy-in of MCED tests and to develop a communication tool to support informed decision making. We conducted a cross-sectional qualitative study using grounded theory. Twenty participants, including primary care patients and caregivers of patients with cancer from the University of Alabama at Birmingham, were interviewed between January and August 2024. Semi-structured interviews examined participants' knowledge, beliefs, and behaviors related to cancer screening and MCED testing. Interviews were analyzed using grounded theory and a constant comparative method to identify themes, and findings informed the development of a communication tool highlighting critical aspects of MCED testing. Participants expressed interest in early cancer detection, citing benefits such as improved health outcomes and peace of mind. However, enthusiasm was tempered by concerns about overdiagnosis, emotional distress from ambiguous results, test accuracy, financial burden, and uncertainties surrounding MCED testing. On the basis of these findings, a preliminary communication tool was developed to address critical aspects of MCED testing, including test accuracy and reliability, scope of testing, emotional implications, costs and insurance, follow-up care, and privacy concerns. This prototype was designed to facilitate patient-provider discussions by prioritizing the domains identified as essential for informed decision making. Although MCED tests are viewed as promising, their adoption requires addressing key barriers, including emotional, financial, and logistical challenges. The identified communication domains, and the preliminary communication tool informed by these findings, provide an initial framework for supporting patient-centered discussions and integration of MCED screening into clinical practice. Future research should focus on testing and refining the tool to evaluate its effectiveness in diverse populations.