title: Pathways to Lung Cancer Diagnosis: A Qualitative Study of Patients and General Practitioners about Diagnostic and Pretreatment Intervals.
abstract: BACKGROUND
  Pathways to lung cancer diagnosis and treatment are complex. International evidence shows significant variations in pathways. Qualitative research investigating pathways to lung cancer diagnosis rarely considers both patient and general practitioner views simultaneously.
  
  
  OBJECTIVE
  To describe the lung cancer diagnostic pathway, focusing on the perspective of patients and general practitioners about diagnostic and pretreatment intervals.
  
  
  METHODS
  This qualitative study of patients with lung cancer and general practitioners in Australia used qualitative interviews or a focus group in which participants responded to a semistructured questionnaire designed to explore experiences of the diagnostic pathway. The Model of Pathways to Treatment (the Model) was used as a framework for analysis, with data organized into (1) events, (2) processes, and (3) contributing factors for variations in diagnostic and pretreatment intervals.
  
  
  RESULTS
  Thirty participants (19 patients with lung cancer and 11 general practitioners) took part. Nine themes were identified during analysis. For the diagnostic interval, these were: (1) taking patient concerns seriously, (2) a sense of urgency, (3) advocacy that is doctor-driven or self-motivated, and (4) referral: "knowing who to refer to." For the pretreatment interval, themes were: (5) uncertainty, (6) psychosocial support for the patient and family before treatment, and (7) communication among the multidisciplinary team and general practitioners. Two cross-cutting themes were: (8) coordination of care and "handing over" the patient, and (9) general practitioner knowledge about lung cancer. Events were perceived as complex, with diagnosis often being revealed over time, rather than as a single event. Contributing factors at patient, system, and disease levels are described for both intervals.
  
  
  CONCLUSIONS
  Patients and general practitioners expressed similar themes across the diagnostic and pretreatment intervals. Significant improvements could be made to health systems to facilitate better patient and general practitioner experiences of the diagnostic pathway. This novel presentation of patient and general practitioner perspectives indicates that systemic interventions have a role in timely and appropriate referrals to specialist care and coordination of investigations. Systemic interventions may alleviate concerns about urgency of diagnostic workup, communication, and coordination of care as patients transition from primary to specialist care.
authors.affiliation: 1 Sydney Catalyst Translational Cancer Research Centre.
authors.forename: Nicole M
authors.identifier: http://orcid.org/0000-0002-0715-1405
authors.initials: NM
authors.lastname: Rankin
authors.affiliation: 1 Sydney Catalyst Translational Cancer Research Centre.
authors.forename: Sarah
authors.initials: S
authors.lastname: York
authors.affiliation: 2 St. Vincent's Hospital and Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia; and.
authors.forename: Emily
authors.initials: E
authors.lastname: Stone
authors.affiliation: 3 Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Barnes
authors.affiliation: 4 Research in Implementation Science and eHealth, Faculty of Health Sciences.
authors.forename: Deborah
authors.initials: D
authors.lastname: McGregor
authors.affiliation: 1 Sydney Catalyst Translational Cancer Research Centre.
authors.forename: Michelle
authors.identifier: http://orcid.org/0000-0002-3651-4797
authors.initials: M
authors.lastname: Lai
authors.affiliation: 1 Sydney Catalyst Translational Cancer Research Centre.|4 Research in Implementation Science and eHealth, Faculty of Health Sciences.
authors.forename: Tim
authors.initials: T
authors.lastname: Shaw
authors.affiliation: 1 Sydney Catalyst Translational Cancer Research Centre.|5 Psycho-Oncology Co-operative Research Group, School of Psychology, and.|6 Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Phyllis N
authors.initials: PN
authors.lastname: Butow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003142:Communication; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D017144:Focus Groups; D058005:General Practitioners; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research; D012017:Referral and Consultation
keywords: delivery of health care; diagnosis; lung neoplasms; primary health care; qualitative research