Barriers to lung cancer care: Health professionals’ perspectives.
Dunn, J., Garvey, G., Valery, P. C., Ball, D., Fomg, K. M., Vinod, S., O’Connell, D. L., & Chambers, S. K. (2017). Barriers to lung cancer care: Health professionals’ perspectives. Supportive Care in Cancer, 25(2):497-504. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5196009/
Kirsten Mooney (ANZ-LCNF Western Australia Representative)
Thoracic Cancer Clinical Nurse Consultant
WA Cancer & Palliative Network
The purpose of this study was to explore the views of Australian health professionals, employed in a lung cancer context, on the barriers to lung cancer care which may result in variation in patient management and survival.
This was a qualitative study that used semi-structured interviews in a group of 31 multidisciplinary health professionals. The majority of participants were registered nurses (29%). While health professional representation from all states and the Australian Capital Territory is noted, ninety-one health professionals were initially contacted to participate in the study.
Study participants had, on average, 16 years’ experience in the lung cancer setting. However, it was not clear as to the concentration of lung cancer experience within the disciplines – for example GPs do not tend to see many lung cancer patients during the span of their career. The fact that these health professionals expressed an interest in participating in this study, however, could suggest that they do have experience and interest in this field.
Three superordinate themes were identified: illness representations, cultural influences, and health system context.
Three sub-themes were identified reflective of illness representations: 1) symptoms attributed as smoking related but not cancer, 2) health-related stigma, and 3) therapeutic nihilism.
1) Symptoms attributed to smoking related but not cancer – the vague nature of some lung cancer symptoms, in conjunction with patients and GPs attributing symptoms to smoking, were perceived to result in delays in investigation and treatment.
2) Health-related stigma – is commonly reported as experienced by lung cancer patients, largely because of the causal link to smoking. Health-related stigma can result in patients not being proactive in seeking advice or treatment due to shame and feeling as though they have brought this disease on themselves. The authors report that the study participants also perceived that anti-smoking campaigns in the media can contribute to stigma and that a more positive message about early detection and treatment options could help reduce stigma. Anti-smoking campaigns were also thought to result in nihilistic views on success of lung cancer treatment, especially when they focused on “not being around for my children”. In other words, some anti-tobacco campaigns which focus on smoking-related illnesses in an attempt to dissuade people from smoking could be very distressing for a person with diagnosed lung cancer.
3) Therapeutic nihilism – emerged in the interviews, alongside the view that treatment for lung cancer was futile and this was seen as affevting not only attendance for treatment but other health behaviours such as smoking cessation.
Participants perceived that relationship to country, language barriers, being away from family and sociodemographic factors played a large part in “non-compliance” with lung cancer treatment, especially with the first nation population. Rurality also played a significant part in reduction of access to treatment.
In this study, there were only two Aboriginal Health Workers and four rural representatives interviewed. A broader representation would have been beneficial given these points of discussion related to first nation people and the rural population.
Health system context
The health system context, generally, was described as contributing to delays in people diagnosed with lung cancer accessing treatment. Contributing factors included lack of multidisciplinary and palliative care services in rural and regional areas and resultant distance to treatment centres; poor care coordination; and the lack of a screening tool for early detections. Interestingly, case presentation and discussion at an MDM was not raised as something that could reduce delays and therapeutic nihilism, as well as maximising treatment options.
This was an interesting and well-referenced article that addressed common barriers relating to lung cancer. The authors recognised that key issues were highlighted by experienced lung cancer health professionals, however, it was a small study and the purposive sampling approach may limit transferability of these perspectives to a wider cancer care workforce.
Overall, it was an enjoyable read!