Patient perspectives and experience on the diagnostic pathway of lung cancer: A qualitative study

Abstract

Objectives: Lung cancer is one of the most common types of cancer, with high mortality rate and a significant burden of symptoms. It is therefore important to assess patients’ perceived quality of life during the diagnostic process and treatment. Knowledge of and attention to patients’ perspectives, experiences, and expectations in relation to lung cancer diagnostic pathways is limited. The aim of the study is to contribute with patients’ and relatives’ experiences with and their assessment of the quality of a hospital-based lung cancer diagnostic pathway. Methods: A qualitative study was conducted, comprising participant observation with 20 patients and semi-structured interviews with further 19 patients referred to the Lung Cancer Package, which initiates a fast track diagnostic pathway in a hospital setting. Data were obtained over a period of 9 months and analysed in collaboration with an interdisciplinary team of health professionals. The purpose was to further develop existing management strategies of the fast track diagnostic pathway based on patient’s perspectives. Results: Patients associated the fast track diagnostic pathway with high levels of anxiety due to the immediate risk of a lung cancer diagnosis. Although patients experienced the fast track programme as very challenging, they still wanted to move through the diagnostic pathway as quickly as possible. The patients expressed a need for support from relatives and repeatedly required information in multiple formats from health professionals throughout the diagnostic pathway. Conclusions: The study provided insight into the need for developing the fast track diagnostic pathway with a focus on patient anxiety, network involvement, and information strategies. The results qualified clinical practice with an increased focus on managing patients’ anxiety, raised awareness to involve relatives in the diagnostic process, and relaying information in dialogue with patients and their relatives, including management strategies to support patients through diagnostic investigations in the fast track programme.

Obstacles for patients with a low socio‐economic status treated within the head and neck cancer pathway: A multiple case study

“…Other studies have also shown challenges in the interaction between patients and health professionals during cancer pathways. Christensen and Huniche (2020) showed that patients going through fast‐track treatment for lung cancer experienced challenges remembering information they had received, especially during the first part of the pathway. The lacking information subsequently caused confusion about the purpose of the consultations they needed to attend.…”

“…The lacking information subsequently caused confusion about the purpose of the consultations they needed to attend. The authors showed that the health professionals, on their part, expected the patients to be well informed about the consultations (Christensen & Huniche, 2020). Moreover, Merrild et al (2016) showed how especially patients of a low social class had difficulties overseeing several elements in a conversation with the doctor, why the decisive theme for the conversation was often focused on issues the doctor found important, creating an unequal interaction during the consultation (Merrild et al, 2016).…”

A support nurse may strengthen the participation of patients with low socio‐economic status in treatment pathways of head and neck cancer: A theory‐based evaluation

“…However, in all three studies, the nurse navigators were not described to accompany the patients at other consultations than the ones scheduled specifically with the nurse navigator. We have previously reported that patients with a low SES were challenged by the information provided during consultations to an extent where the risk of them misunderstanding important information was high (Mondahl et al, 2023), which has also been argued by others internationally (Borrayo et al, 2020;Christensen & Huniche, 2020). Thus, follow-ups on given information may possibly be challenged by misunderstandings of the information that may very well not be clear to the patients.…”

Interventions to improve early cancer diagnosis of symptomatic individuals: a scoping review

“…Nine published articles on centralised or coordinated diagnostic services for adult lung cancer (n=5) and breast cancer (n=4) patients were identified. 20 23 32 33 44 54-56 93 Five were from Canada, 23 33 44 54 55 and there was one each from Denmark, 20 New Zealand, 93 South Africa 56 and the UK. 32 The focus and metrics for assessment of the effectiveness of these diagnostic services varied, but all were found to be effective.…”

“…23 The diagnostic services also include the rapid investigation clinic in a tertiary health centre in Montreal, Canada established to coordinate and accelerate the workup of patients with suspected lung cancer, 33 the improved respiratory fast track clinic in Northland district of New Zealand that comprises reserved slots for CT for those referred with a suspicion of lung cancer, bronchoscopy slots and CT-guided biopsy, 93 and the Danish lung cancer package at the Center for Lung Cancer, Odense University Hospital, Odense, Denmark, a fast-track diagnostic pathway in the hospital setting. 20 Further, there was the rapid access breast clinic in British Columbia, Canada that provides close collaboration between clinicians and radiologists, facilitated by clinical pathways and nurse navigation, 54 55 the diagnostic assessment units in Ontario, Canada, focusing on diagnosis at a dedicated breast assessment unit, 44 and the breast clinic at a tertiary hospital in Western Cape Province of South Africa, an open-access one-stop diagnostic breast clinic where women may present with a letter from a primary level provider (nurse practitioner or doctor) and receive the same day clinical and cytological evaluation with referral to the combined breast clinic if the breast cytology is positive for malignancy. 56 In addition to the above, one unpublished article was identified.…”