Pathways to lung cancer diagnosis among individuals who did not receive lung cancer screening: a qualitative study
Abstract Background Although early detection of lung cancer through screening is associated with better prognosis, most lung cancers are diagnosed among unscreened individuals. We therefore sought to characterize pathways to lung cancer diagnosis among unscreened individuals. Methods Participants we...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | BMC Primary Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12875-023-02158-7 |
| _version_ | 1797451964217294848 |
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| author | Rachel D. McCarty Mollie E. Barnard Katherine A. Lawson-Michod Makelle Owens Sarah E. Green Samantha Derzon Lea Karabegovic Wallace L. Akerley Melissa H. Watt Jennifer A. Doherty Laurie Grieshober |
| author_facet | Rachel D. McCarty Mollie E. Barnard Katherine A. Lawson-Michod Makelle Owens Sarah E. Green Samantha Derzon Lea Karabegovic Wallace L. Akerley Melissa H. Watt Jennifer A. Doherty Laurie Grieshober |
| author_sort | Rachel D. McCarty |
| collection | DOAJ |
| description | Abstract Background Although early detection of lung cancer through screening is associated with better prognosis, most lung cancers are diagnosed among unscreened individuals. We therefore sought to characterize pathways to lung cancer diagnosis among unscreened individuals. Methods Participants were individuals with lung cancer who did not undergo asymptomatic lung cancer screening (n = 13) and healthcare providers who may be involved in the pathway to lung cancer diagnosis (n = 13). We conducted semi-structured interviews to identify themes in lung cancer patients’ narratives of their cancer diagnoses and providers’ personal and/or professional experiences of various pathways to lung cancer diagnoses, to identify delays in diagnosis. We audio-recorded, transcribed, and coded interviews in two stages. First, we conducted deductive coding using three time-period intervals from the Models of Pathways to Treatment framework: appraisal, help-seeking, and diagnostic (i.e., excluding pre-treatment). Second, we conducted inductive coding to identify themes within each time-period interval, and classified these themes as either barriers or facilitators to diagnosis. Coding and thematic summarization were completed independently by two separate analysts who discussed for consensus. Results Eight of the patient participants had formerly smoked, and five had never smoked. We identified eight barrier/facilitator themes within the three time-period intervals. Within the appraisal interval, the barrier theme was (1) minimization or misattribution of symptoms, and the facilitator theme was (2) acknowledgment of symptoms. Within the help-seeking interval, the barrier theme was (3) hesitancy to seek care, and the facilitator theme was (4) routine care. Within the diagnosis interval, barrier themes were (5) health system challenges, and (6) social determinants of health; and facilitator themes were (7) severe symptoms and known risk factors, and (8) self-advocacy. Many themes were interrelated, including minimization or misattribution of symptoms and hesitancy to seek care, which may collectively contribute to care and imaging delays. Conclusions Interventions to reduce hesitancy to seek care may facilitate timely lung cancer diagnoses. More prompt referral to imaging—especially computed tomography (CT)—among symptomatic patients, along with patient self-advocacy for imaging, may reduce delays in diagnosis. |
| first_indexed | 2024-03-09T15:00:57Z |
| format | Article |
| id | doaj.art-5f0ece171fb648e2a5bcc062d8f89df8 |
| institution | Directory Open Access Journal |
| issn | 2731-4553 |
| language | English |
| last_indexed | 2024-03-09T15:00:57Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Primary Care |
| spelling | doaj.art-5f0ece171fb648e2a5bcc062d8f89df82023-11-26T13:53:23ZengBMCBMC Primary Care2731-45532023-10-0124111110.1186/s12875-023-02158-7Pathways to lung cancer diagnosis among individuals who did not receive lung cancer screening: a qualitative studyRachel D. McCarty0Mollie E. Barnard1Katherine A. Lawson-Michod2Makelle Owens3Sarah E. Green4Samantha Derzon5Lea Karabegovic6Wallace L. Akerley7Melissa H. Watt8Jennifer A. Doherty9Laurie Grieshober10Huntsman Cancer Institute, University of UtahHuntsman Cancer Institute, University of UtahHuntsman Cancer Institute, University of UtahDepartment of Internal Medicine, Spencer Fox Eccles School of Medicine, University of UtahDepartment of Internal Medicine, Spencer Fox Eccles School of Medicine, University of UtahDepartment of Internal Medicine, Spencer Fox Eccles School of Medicine, University of UtahDepartment of Internal Medicine, Spencer Fox Eccles School of Medicine, University of UtahHuntsman Cancer Institute, University of UtahDepartment of Population Health Sciences Spencer Fox Eccles School of Medicine, University of Utah Intermountain Healthcare, University of UtahHuntsman Cancer Institute, University of UtahHuntsman Cancer Institute, University of UtahAbstract Background Although early detection of lung cancer through screening is associated with better prognosis, most lung cancers are diagnosed among unscreened individuals. We therefore sought to characterize pathways to lung cancer diagnosis among unscreened individuals. Methods Participants were individuals with lung cancer who did not undergo asymptomatic lung cancer screening (n = 13) and healthcare providers who may be involved in the pathway to lung cancer diagnosis (n = 13). We conducted semi-structured interviews to identify themes in lung cancer patients’ narratives of their cancer diagnoses and providers’ personal and/or professional experiences of various pathways to lung cancer diagnoses, to identify delays in diagnosis. We audio-recorded, transcribed, and coded interviews in two stages. First, we conducted deductive coding using three time-period intervals from the Models of Pathways to Treatment framework: appraisal, help-seeking, and diagnostic (i.e., excluding pre-treatment). Second, we conducted inductive coding to identify themes within each time-period interval, and classified these themes as either barriers or facilitators to diagnosis. Coding and thematic summarization were completed independently by two separate analysts who discussed for consensus. Results Eight of the patient participants had formerly smoked, and five had never smoked. We identified eight barrier/facilitator themes within the three time-period intervals. Within the appraisal interval, the barrier theme was (1) minimization or misattribution of symptoms, and the facilitator theme was (2) acknowledgment of symptoms. Within the help-seeking interval, the barrier theme was (3) hesitancy to seek care, and the facilitator theme was (4) routine care. Within the diagnosis interval, barrier themes were (5) health system challenges, and (6) social determinants of health; and facilitator themes were (7) severe symptoms and known risk factors, and (8) self-advocacy. Many themes were interrelated, including minimization or misattribution of symptoms and hesitancy to seek care, which may collectively contribute to care and imaging delays. Conclusions Interventions to reduce hesitancy to seek care may facilitate timely lung cancer diagnoses. More prompt referral to imaging—especially computed tomography (CT)—among symptomatic patients, along with patient self-advocacy for imaging, may reduce delays in diagnosis.https://doi.org/10.1186/s12875-023-02158-7Lung cancerPathways to diagnosisQualitative studyModels of pathways to treatment |
| spellingShingle | Rachel D. McCarty Mollie E. Barnard Katherine A. Lawson-Michod Makelle Owens Sarah E. Green Samantha Derzon Lea Karabegovic Wallace L. Akerley Melissa H. Watt Jennifer A. Doherty Laurie Grieshober Pathways to lung cancer diagnosis among individuals who did not receive lung cancer screening: a qualitative study BMC Primary Care Lung cancer Pathways to diagnosis Qualitative study Models of pathways to treatment |
| title | Pathways to lung cancer diagnosis among individuals who did not receive lung cancer screening: a qualitative study |
| title_full | Pathways to lung cancer diagnosis among individuals who did not receive lung cancer screening: a qualitative study |
| title_fullStr | Pathways to lung cancer diagnosis among individuals who did not receive lung cancer screening: a qualitative study |
| title_full_unstemmed | Pathways to lung cancer diagnosis among individuals who did not receive lung cancer screening: a qualitative study |
| title_short | Pathways to lung cancer diagnosis among individuals who did not receive lung cancer screening: a qualitative study |
| title_sort | pathways to lung cancer diagnosis among individuals who did not receive lung cancer screening a qualitative study |
| topic | Lung cancer Pathways to diagnosis Qualitative study Models of pathways to treatment |
| url | https://doi.org/10.1186/s12875-023-02158-7 |
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