'I had to tell my GP I had lung cancer': patient perspectives of hospital- and community-based lung cancer care

The role of general practice to address the supportive care needs of Australian cancer survivors: a qualitative study

Background Cancer survivors have a broad range of supportive care needs that are not consistently managed in general practice. Understanding the barriers primary healthcare providers face in providing high quality supportive care is crucial for improving the delivery of supportive care in general practice. Methods This Australian qualitative study involved semi-structured interviews with general practitioners (n =9), practice nurses (n =8), and a community liaison worker employed in general practice (n =1), to explore barriers and facilitators to identifying and managing supportive care for cancer survivors. Data were thematically analysed to develop recurring themes related to the identification and provision of supportive care. Results Four major themes were developed: identification of supportive care needs, time and provision of supportive care, challenges in supportive care for diverse populations, and desire for more information. Improved education; enhanced communication across all levels of healthcare, including centralised access to patient information; and greater knowledge of available services were highlighted as facilitators to the management of supportive care for cancer survivors. Conclusions Targeted efforts to support the facilitators identified here can contribute to more effective management of supportive care for diverse cancer survivor populations to improve the overall quality of care and health outcomes for these individuals.

Patient and carer experiences of lung cancer referral pathway in a regional health service: a qualitative study

BACKGROUND

Lung cancer referral pathways aim to reduce delays and improve referral patterns of people with suspected lung cancer.

AIM

As part of implementing a lung cancer referral pathway at a regional Australian hospital, this study aimed to explore the experiences and perceptions of people with lung cancer and their carers.

METHODS

In-depth interviews were used to elicit data for thematic analysis in this cross-sectional descriptive qualitative study. Patients with newly diagnosed lung cancer and their carers at a regional academic cancer centre were invited to participate in interviews. Five interviews were conducted face-to-face, and 14 interviews were conducted by telephone (as per interviewee preference). Interviews were audiorecorded, transcribed and qualitatively analysed. Descriptive phrases were used to generate initial inductive codes and themes.

RESULTS

Nineteen participants approached agreed to take part in the study. Factors that positively impacted the care experience were good communication, timeliness and patient advocacy and support. Improper communication, long waiting times for investigations and appointments, uncertainty about the process and inconsistent advice from providers negatively impacted the care experience. Participants preferred face-to-face or video-linked consultations over telephone consultations.

CONCLUSIONS

Understanding the experiences of rural and regional patients and carers with the lung cancer referral pathway is important to improve quality of care. Implementing changes to the referral pathway to improve patient and carer experiences needs to be an ongoing quality improvement exercise.

Older patients' perceptions of the quality of acute cancer care: An integrative review-A mixed-method approach

AIM

This integrative review aimed to describe the perceptions of the quality of care of older patients (aged 65 and above) living with cancer in acute-care settings.

METHODS

We identified relevant research suitable for inclusion criteria through systematic searches of the PubMed®, EBSCOhost Academic Search Premier®, Scopus® and Web of Science® databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework and the Synthesis Without Meta-analysis (SWiM) guidelines were used to conduct the research and report the results. The quality of the studies was evaluated using the modified Critical Skills Appraisal Programme (CASP) checklist.

RESULTS

A total of 24 studies met the inclusion criteria. The data analysis revealed that care quality could be described through three distinct themes: individuality, a sense of security and respectful encounters.

CONCLUSION

The perceptions of older people living with cancer regarding the quality of acute care have not been extensively covered in the literature. Health- and age-related challenges, patients' overall life situation, clear, realistic information about care and the future and respect during encounters should be given attention.

IMPLICATIONS FOR PRACTICE

Patient-centred and tailored care, considering the heterogeneity of the population and support for independence, is needed.

The meaning of life according to patients with advanced lung cancer: a qualitative study

PURPOSE

This qualitative study explores the meaning of life and end-of-life coping strategies among patients in China with advanced lung cancer.

METHODS

We conducted in-depth interviews with 21 hospitalized patients with advanced lung cancer and analysed the data using the 7-step Colaizzi method.

RESULTS

The analysis revealed themes in patients' experiences and feelings about living with a terminal illness. These include: 1) The core of the meaning of life is "self-iteration," which includes self-recognition and cherishing life; 2) The existence form of the meaning of life is "yu-wei," including self-reliance and altruism; 3) The meaning of life is embodied in three levels: the past, present, and future. The past includes gratitude, guilt and remorse, and avoidance; the present includes using the support system, positive response, independence, and integrity; the future includes accompanying relatives, preparing for death, living a high quality of life, and worrying.

CONCLUSION

Meaning of life is a multidimensional and diverse concept among patients with advanced lung cancer. Medical care providers and family members can provide targeted professional guidance and psychological support according to patients' characteristics to help them discover their meaning of life, improve their quality of life, and achieve a positive end-of-life perspective.

Healthcare practices that increase the quality of care in cancer trajectories from a general practice perspective: a scoping review

OBJECTIVE

General practice plays an important role in cancer trajectories, and cancer patients request the continuous involvement of general practice. The objective of this scoping review was to identify healthcare practices that increase the quality of care in cancer trajectories from a general practice perspective.

DESIGN, SETTING, AND SUBJECTS

A scoping review of the literature published in Danish or English from 2010 to 2020 was conducted. Data was collected using identified keywords and indexed terms in several databases (PubMed, MEDLINE, EBSCO CINAHL, Scopus, and ProQuest), contacting key experts, searching through reference lists, and reports from selected health political, research- and interest organizations' websites.

MAIN OUTCOME MEASURES

We identified healthcare practices in cancer trajectories that increase quality care. Identified healthcare practices were grouped into four contextual domains and allocated to defined phases in the cancer trajectory. The results are presented according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR).

RESULTS

A total of 45 peer-reviewed and six non-peer-reviewed articles and reports were included. Quality of care increases in all phases of the cancer trajectory when GPs listen carefully to the full story and use action plans. After diagnosis, quality of care increases when GPs and practice staff have a proactive care approach, act as interpreters of diagnosis, treatment options, and its consequences, and engage in care coordination with specialists in secondary care involving the patient.

CONCLUSION

This scoping review identified healthcare practices that increase the quality of care in cancer trajectories from a general practice perspective. The results support general practice in investigating own healthcare practices and identifying possibilities for quality improvement.KEY POINTSIdentified healthcare practices in general practice that increase the quality of care in cancer trajectories:Listen carefully to the full storyUse action plans and time-out-consultationsPlan and provide proactive careAct as an interpreter of diagnosis, treatment options, and its consequences for the patientCoordinate care with specialists, patients, and caregivers with mutual respectIdentified barriers for quality of care in cancer trajectories are:Time constraints in consultationsLimited accessibility for patients and caregiversHealth practices to increase the quality of care should be effective, safe, people-centered, timely, equitable, integrated, and efficient. These distinctions of quality of care, support general practice in investigating and improving quality of care in cancer trajectories.