title: Patient perceptions of barriers to the early diagnosis of lung cancer and advice for health service improvement.
abstract: OBJECTIVE
  Patient and systematic factors within primary and secondary care contribute to delay in timely diagnosis of lung cancer. This qualitative study aimed to explore New Zealand service users' experiences of the pathway to lung cancer diagnosis, identify factors contributing to delay and provide advice for service improvement.
  
  
  METHODS
  Two samples were recruited. Patients who presented to a hospital emergency department with suspicious symptoms (n = 19) were interviewed individually. Those with confirmed lung cancer (n = 20) took part in a focus group. Similar semi-structured interview schedules were used. Interviews and focus groups were audiorecorded and thematic analyses performed. Evident commonality led to an integrated interpretation.
  
  
  RESULTS
  Patient delay was common but most had seen a GP before referral. No ED participant had seen a respiratory specialist prior ED admission, but after that, most had a seamless pathway. This contrasts with long waits for outpatient participants. Two central themes, 'access to health services' and 'processes of care', described factors influencing delay. Subthemes highlighted issues relating to symptom interpretation, health beliefs, provider continuity, relationships and perceived expertise that contributed to patient and GP delay. System complexity, information systems and resourcing issues were identified as barriers at the primary-secondary care interface and within secondary care.
  
  
  CONCLUSIONS
  Reasons for diagnostic delay are complex and multifactorial. Solutions include community initiatives to educate and resource at-risk patients to seek help, supporting and resourcing primary care to increase timely referral and implementing strategies to reduce system complexity for GPs and patients, and the employment of care coordinators.
authors: Health Systems, School of Population Health, University of Auckland, Auckland, New Zealand.
authors: Lisa
authors: L
authors: Walton
authors: Rob
authors: R
authors: McNeill
authors: Wendy
authors: W
authors: Stevens
authors: Melissa
authors: M
authors: Murray
authors: Chris
authors: C
authors: Lewis
authors: Denise
authors: D
authors: Aitken
authors: Jeff
authors: J
authors: Garrett
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D057210:Delayed Diagnosis / Q000517:prevention & control* / Q000523:psychology / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D058006:General Practice / Q000458:organization & administration*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012938:Social Perception; D063189:Symptom Assessment / Q000379:methods
keywords: Access to care; cancer care/oncology; continuity of care; doctor–patient relationship; primary care.