Oral Presentation NSW State Cancer Conference 2023

The Patient Experience of Pathways to Lung Cancer Diagnosis in Primary Care: a Mixed Methods Investigation of Factors Contributing to Diagnostic Delays in New South Wales, Australia. (#42)

Kimberley Mander 1 , Bea Brown 1 , Adeline Yap 1 , Kirsty Galpin 1 , Jane Young 1
  1. University of Sydney, Camperdown, NSW, Australia

Purpose: Patients with lung cancer can experience prolonged diagnostic intervals. The reasons are often multifaceted and not well elucidated through quantitative methods. This study investigated the diagnostic pathway prior to a confirmed lung cancer diagnosis, exploring Patient, Healthcare Provider and System, and Disease factors that contributed to protracted diagnoses. 

Methods: A mix-method study design, including audit of general practice (GP) records and semi-structured qualitative patient interviews was used.  Eligible patients were identified through the EnRICH Program. Patient characteristics and clinical data were obtained via the EnRICH database. GP surveys were distributed electronically. Qualitative interviews were audio-recorded via telephone/videoconference and were analysed using Framework methods. The Andersen model of total patient delay [1] informed data interpretation for a standardised approach to measure the diagnostic pathway.

Results: 29 patient interviews and 30 GP surveys were completed.  Three main themes and multiple sub-themes were identified:

  1. Patient Factors: (i) agency; (ii) health literacy; (iii) relationship with GP; (iv) socioeconomic status and lifestyle
  2. Healthcare Provider and System Factors: (i)low index of suspicion; (ii) access to timely and appropriate diagnostic procedures/results; (iii) availability of GP appointments; (iv) adherence to optimal care pathway
  3. Disease Factors: (i)asymptomatic; (ii) inconclusive investigations; (iii) atypical tumour presentation; (iv) comorbidities

Conclusions: Early detection and subsequent prompt treatment for lung cancer afford greater treatment options and are associated with better patient outcomes. Healthcare Provider and System factors had the greatest impact on timely investigation leading to a lung cancer diagnosis.  Interventions addressing this area of the pathway are likely to yield the most benefit in streamlining and accelerating the process to benefit patients and inform system resourcing. 

Implications for Lung Cancer patients: Many patients who perceived they had a protracted diagnostic journey disclosed a feeling of ‘what if (it was caught earlier)?’. This was particularly evident for patients diagnosed at an advanced stage and was often accompanied by psychological distress for both the patient and their support network. Streamlining and accelerating the diagnostic pathway to expedite diagnosis will reduce these negative impacts. 

Implications for GPs: Despite publication of the optimal care pathway for lung cancer [2, 3] and digital tools for GPs [4], a systematic approach to investigating symptoms suspicious for lung cancer was not uniformly evident in the findings of this study. Future research should aim to better understand what is driving this disconnection and seek to improve awareness and adherence to the optimal care pathway.   

  1. 1. Walter F, Webster A, Scott S, Emery J: The Andersen Model of Total Patient Delay: a systematic review of its application in cancer diagnosis. J Health Serv Res Policy 2012, 17(2):110-118.
  2. 2. Victoria CCVaDoH: Optimal care pathway for people with lung cancer. In. Edited by Victoria DoH, Second Edition ed; 2021.
  3. 3. Health Pathways (2022) https://sydney.communityhealthpathways.org
  4. 4. Cancer Australia (2023) https://www.canceraustralia.gov.au/ISLCguide