1 Sydney Catalyst Translational Cancer Research Centre.
2 St. Vincent's Hospital and Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia; and.
Ann Am Thorac Soc. 2017 May;14(5):742-753. doi: 10.1513/AnnalsATS.201610-817OC.
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.
To describe the lung cancer diagnostic pathway, focusing on the perspective of patients and general practitioners about diagnostic and pretreatment intervals.
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.
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.
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.
肺癌的诊断和治疗途径复杂。国际证据表明，这些途径存在显著差异。很少有研究从定性角度同时调查患者和全科医生对肺癌诊断途径的看法。
描述肺癌的诊断途径，重点关注患者和全科医生对诊断和治疗前间隔的看法。
本研究采用定性方法，纳入澳大利亚的肺癌患者和全科医生，使用定性访谈或焦点小组，参与者对设计用于探索诊断途径的半结构化问卷做出回应。采用治疗途径模型（Model）作为分析框架，将数据组织成（1）事件，（2）过程和（3）导致诊断和治疗前间隔变化的因素。
30 名参与者（19 名肺癌患者和 11 名全科医生）参与了研究。分析中确定了 9 个主题。在诊断间隔方面，这些主题是：（1）认真对待患者的关注，（2）紧迫感，（3）医生驱动或自我激励的倡导，以及（4）转诊：“知道向谁转诊”。在治疗前间隔方面，主题是：（5）不确定性，（6）治疗前为患者及其家属提供心理社会支持，以及（7）多学科团队和全科医生之间的沟通。两个交叉主题是：（8）护理协调和“移交”患者，以及（9）全科医生对肺癌的了解。事件被认为是复杂的，诊断通常是随着时间的推移而揭示的，而不是单一事件。描述了两个间隔的患者、系统和疾病层面的影响因素。
患者和全科医生在诊断和治疗前间隔方面表达了相似的主题。卫生系统可以进行重大改进，以改善患者和全科医生对诊断途径的体验。这种新颖的患者和全科医生观点表明，系统干预措施在及时和适当的转介至专科护理以及调查协调方面发挥作用。系统干预措施可能会减轻对诊断工作紧迫性、沟通和护理协调的担忧，因为患者从初级护理转向专科护理。
