Sydney Medical School, University of Sydney, New South Wales, Australia.
Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
Asia Pac J Clin Oncol. 2021 Apr;17(2):e77-e86. doi: 10.1111/ajco.13335. Epub 2020 Apr 16.
Delays in lung cancer diagnosis and treatment can impact survival. We explored reasons for delays experienced by patients with lung cancer to identify themes and strategies for improvement.
We used national timeframe recommendations and standardized definitions to identify General Practitioners and specialists caring for 34 patients who experienced delays in our previous Medicare data linkage study. Clinicians participated in a survey and interview, including qualitative (exploratory, open-ended questions) and quantitative (rating scales) components. Exploratory content analysis, cross-case triangulation, and descriptive statistics were performed. Krippendorff's coefficient was used to assess level of agreement between clinicians and patients, and among clinicians, on perceived delays.
Overall, 27 out of 50 (54%) eligible clinicians participated (including 11 respiratory physicians and seven medical oncologists). Dominant themes for perceived causes of delay included referral barriers, limited General Practitioner (GP) awareness of subtle clinical presentations, insufficient radiology interpretation, and lack of cancer coordinators. "Unavoidable" delays may occur due to clinical circumstances. Awareness and uptake of referral and timeframe guidelines were low, with clinicians using professional networks over guidelines. There was no consistent agreement on perceived delays between patients and clinicians, and among clinicians (Krippendorff's coefficient .03 [P = .8]).
Strategies for minimizing avoidable delays include efficient GP to specialist referral and more lung cancer coordinators to assist with patient expectations and waitlist management. Clinicians' reliance on experience, rather than guidelines, indicates need to review guideline utility. Raising awareness of benchmarks and unavoidable barriers may recalibrate perceptions of "delays" to diagnosis and treatment of lung cancer.
肺癌诊断和治疗的延误会影响患者的生存。我们探讨了肺癌患者延误的原因，以确定改善的主题和策略。
我们使用国家时间框架建议和标准化定义，确定了在我们之前的医疗保险数据链接研究中经历延误的 34 名患者的全科医生和专家。临床医生参与了一项调查和访谈，包括定性（探索性、开放式问题）和定量（评分量表）部分。进行了探索性内容分析、跨案例三角测量和描述性统计分析。使用 Krippendorff 系数评估临床医生和患者之间以及临床医生之间对感知延迟的一致性。
总体而言，50 名符合条件的临床医生中有 27 名（包括 11 名呼吸内科医生和 7 名肿瘤内科医生）参与了调查。感知延误原因的主要主题包括转诊障碍、全科医生对细微临床表现的认识有限、影像学解释不足以及缺乏癌症协调员。由于临床情况，可能会出现“不可避免”的延误。对转诊和时间框架指南的认识和采用程度较低，临床医生更倾向于使用专业网络而不是指南。患者和临床医生之间以及临床医生之间对感知延迟的一致性并不一致（Krippendorff 系数为 0.03 [P=0.8]）。
最大限度减少可避免延误的策略包括高效的全科医生到专科医生转诊以及更多的肺癌协调员来协助患者的期望和候补名单管理。临床医生依赖经验而不是指南，表明需要审查指南的实用性。提高对基准和不可避免障碍的认识可能会重新调整对肺癌诊断和治疗中“延误”的看法。
