This qualitative research project explored New Zealand service users’ experiences of the pathway to lung cancer diagnosis, in an attempt to identify factors contributing to delay and provide advice for service improvement. Two patient cohorts were involved: 19 patients who presented to a hospital emergency department with suspicious symptoms were interviewed individually; another 20 with confirmed lung cancer took part in a focus group. Patient delay was common, but most had seen a GP before referral. While none of the emergency department participants had seen a respiratory specialist prior to admission, most had a seamless pathway after admission, whereas long waits were common among outpatient participants. Two central themes, ‘access to health services’ and ‘processes of care’, described factors influencing delay. Issues relating to symptom interpretation, health beliefs, provider continuity, relationships and perceived expertise contributed to patient and GP delay. Barriers at the primary–secondary care interface and within secondary care included system complexity, information systems and resourcing issues. The study researchers recommend the following solutions: include community initiatives to educate and resource at-risk patients to seek help; support and resource primary care to increase timely referral and implement strategies to reduce system complexity for GPs and patients; and the employment of care coordinators.
