title: Lung cancer: an exploration of patient and general practitioner perspectives on the realities of care in rural Western Australia.
abstract: OBJECTIVE
  This study investigates if the pattern of diagnostic testing for suspected lung cancer, stage at diagnosis, patterns of specialist referral and treatment options offered to people in rural Western Australia are similar to those in the metropolitan area. It then explores the barriers to quality care in rural areas as perceived by GPs and patients.
  
  
  METHODS
  There was a review of GP records to obtain clinical and referral information and an in-depth interview with patients and GPs concerning their perspectives of the quality of care.
  
  
  CONCLUSIONS
  We selected age and sex-matched samples of 22 rural and 21 metropolitan patients. Rural patients had more symptoms and took longer to consult their GPs, leading to later diagnosis and fewer treatment options. They experienced longer waits for specialist consultation and underwent less diagnostic testing. The GPs always referred lung cancer patients to a specialist, usually a respiratory physician. Teaching hospitals were preferred because of their comprehensive facilities and multidisciplinary teams. Rural GPs reported distance, time and availability of appointments as barriers; they also raised concerns about late confirmation of diagnosis. Rural and metropolitan patients were equally satisfied with their quality of care, but rural patients desired more information and better communication between hospital and GPs. Facilities for rural patients at some metropolitan hospitals were criticised. In conclusion, rural patients received a different care pattern from metropolitan patients and they and their GPs raised concerns about the equity and quality of lung cancer care.
authors.affiliation: School of Population Health, University of Western Australia, Crawley, Western Australia, Australia. sonj.hall@uq.edu.au
authors.forename: Sonĵa E
authors.initials: SE
authors.lastname: Hall
authors.forename: C D'Arcy J
authors.initials: CD
authors.lastname: Holman
authors.forename: Timothy
authors.initials: T
authors.lastname: Threlfall
authors.forename: Harry
authors.initials: H
authors.lastname: Sheiner
authors.forename: Martin
authors.initials: M
authors.lastname: Phillips
authors.forename: Paul
authors.initials: P
authors.lastname: Katriss
authors.forename: Suzanne
authors.initials: S
authors.lastname: Forbes
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D003142:Communication; D019091:Critical Pathways; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000592:standards*; D012935:Social Justice; D013997:Time Factors; D019037:Urban Health Services / Q000592:standards*; D014904:Western Australia