Understanding the impact of distance and disadvantage on lung cancer care and outcomes: a study protocol.
COM-B model
Informal carer
Lung cancer
Oncology
Patient experience
Qualitative research
Rural health
Urban health
Journal
BMC cancer
ISSN: 1471-2407
Titre abrégé: BMC Cancer
Pays: England
ID NLM: 100967800
Informations de publication
Date de publication:
02 Aug 2024
02 Aug 2024
Historique:
received:
27
02
2024
accepted:
25
07
2024
medline:
3
8
2024
pubmed:
3
8
2024
entrez:
2
8
2024
Statut:
epublish
Résumé
Lung cancer is the third most common cancer in the UK and the leading cause of cancer mortality globally. NHS England guidance for optimum lung cancer care recommends management and treatment by a specialist team, with experts concentrated in one place, providing access to specialised diagnostic and treatment facilities. However, the complex and rapidly evolving diagnostic and treatment pathways for lung cancer, together with workforce limitations, make achieving this challenging. This place-based, behavioural science-informed qualitative study aims to explore how person-related characteristics interact with a person's location relative to specialist services to impact their engagement with the optimal lung pathway, and to compare and contrast experiences in rural, coastal, and urban communities. This study also aims to generate translatable evidence to inform the evidence-based design of a patient engagement intervention to improve lung cancer patients' and informal carers' participation in and experience of the lung cancer care pathway. A qualitative cross-sectional interview study with people diagnosed with lung cancer < 6 months before recruitment (in receipt of surgery, radical radiotherapy, or living with advanced disease) and their informal carers. Participants will be recruited purposively from Barts Health NHS Trust and United Lincolnshire Hospitals NHS Trusts to ensure a diverse sample across urban and rural settings. Semi-structured interviews will explore factors affecting individuals' capability, opportunity, and motivation to engage with their recommended diagnostic and treatment pathway. A framework approach, informed by the COM-B model, will be used to thematically analyse facilitators and barriers to patient engagement. The study aligns with the current policy priority to ensure that people with cancer, no matter where they live, can access the best quality treatments and care. The evidence generated will be used to ensure that lung cancer services are developed to meet the needs of rural, coastal, and urban communities. The findings will inform the development of an intervention to support patient engagement with their recommended lung cancer pathway. The study received NHS Research Ethics Committee (Ref: 23/SC/0255) and NHS Health Research Authority (IRAS ID 328531) approval on 04/08/2023. The study was prospectively registered on Open Science Framework (16/10/2023; https://osf.io/njq48 ).
Sections du résumé
BACKGROUND
BACKGROUND
Lung cancer is the third most common cancer in the UK and the leading cause of cancer mortality globally. NHS England guidance for optimum lung cancer care recommends management and treatment by a specialist team, with experts concentrated in one place, providing access to specialised diagnostic and treatment facilities. However, the complex and rapidly evolving diagnostic and treatment pathways for lung cancer, together with workforce limitations, make achieving this challenging. This place-based, behavioural science-informed qualitative study aims to explore how person-related characteristics interact with a person's location relative to specialist services to impact their engagement with the optimal lung pathway, and to compare and contrast experiences in rural, coastal, and urban communities. This study also aims to generate translatable evidence to inform the evidence-based design of a patient engagement intervention to improve lung cancer patients' and informal carers' participation in and experience of the lung cancer care pathway.
METHODS
METHODS
A qualitative cross-sectional interview study with people diagnosed with lung cancer < 6 months before recruitment (in receipt of surgery, radical radiotherapy, or living with advanced disease) and their informal carers. Participants will be recruited purposively from Barts Health NHS Trust and United Lincolnshire Hospitals NHS Trusts to ensure a diverse sample across urban and rural settings. Semi-structured interviews will explore factors affecting individuals' capability, opportunity, and motivation to engage with their recommended diagnostic and treatment pathway. A framework approach, informed by the COM-B model, will be used to thematically analyse facilitators and barriers to patient engagement.
DISCUSSION
CONCLUSIONS
The study aligns with the current policy priority to ensure that people with cancer, no matter where they live, can access the best quality treatments and care. The evidence generated will be used to ensure that lung cancer services are developed to meet the needs of rural, coastal, and urban communities. The findings will inform the development of an intervention to support patient engagement with their recommended lung cancer pathway.
PROTOCOL REGISTRATION
BACKGROUND
The study received NHS Research Ethics Committee (Ref: 23/SC/0255) and NHS Health Research Authority (IRAS ID 328531) approval on 04/08/2023. The study was prospectively registered on Open Science Framework (16/10/2023; https://osf.io/njq48 ).
Identifiants
pubmed: 39095781
doi: 10.1186/s12885-024-12705-9
pii: 10.1186/s12885-024-12705-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
942Subventions
Organisme : Cancer Research UK
ID : PICATR-2022/100019
Pays : United Kingdom
Organisme : Cancer Research UK
ID : PICATR-2022/100017
Pays : United Kingdom
Organisme : Cancer Research UK
ID : PICATR-2022/100019
Pays : United Kingdom
Organisme : Cancer Research UK
ID : PICATR-2022/100019
Pays : United Kingdom
Informations de copyright
© 2024. The Author(s).
Références
Oliver AL. Lung Cancer: Epidemiology and Screening. Surg Clin North Am. 2022;102(3):335–44.
pubmed: 35671760
doi: 10.1016/j.suc.2021.12.001
Cancer Research UK. Lung Cancer Statistics. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer . Accessed 19 Nov 2023.
NHS England. National Optimal Lung Cancer Pathway: For suspected and confirmed lung cancer: Referral to treatment. https://www.cancerresearchuk.org/sites/default/files/national_optimal_lung_pathway_aug_2017.pdf . Accessed 20 Nov 2023.
Otty Z, Brown A, Sabesan S, Evans R, Larkins S. Optimal care pathways for people with Lung Cancer- a scoping review of the literature. Int J Integr Care. 2020;20(3):14.
pubmed: 33041731
pmcid: 7528692
doi: 10.5334/ijic.5438
Conibear J, Nossiter J, Foster C, West D, Cromwell D, Navani N. The National Lung Cancer audit: the impact of COVID-19. Clin Oncol. 2022;34(11):701–7.
doi: 10.1016/j.clon.2022.09.002
Cancer Research Uk. Deprivation gradient for cancer mortality https://www.cancerresearchuk.org/health-professional/cancer-statistics/mortality/deprivation-gradient#heading-One . Accessed 19 Nov 2023.
Forrest LF, Adams J, Rubin G, White M. The role of receipt and timeliness of treatment in socioeconomic inequalities in lung cancer survival: population-based, data-linkage study. Thorax. 2015;70(2):138–45.
pubmed: 24923873
doi: 10.1136/thoraxjnl-2014-205517
Crosbie PAJ, Gabe R, Simmonds I, Hancock N, Alexandris P, Kennedy M et al. Participation in community-based lung cancer screening: the Yorkshire Lung Screening Trial. Eur Respir J 2022;60(5).
Payne NWS, Brown KF, Delon C, Kotrotsios Y, Soerjomataram I, Shelton J. Socio-economic deprivation and cancer incidence in England: quantifying the role of smoking. PLoS ONE. 2022;17(9):e0272202.
pubmed: 36129905
pmcid: 9491592
doi: 10.1371/journal.pone.0272202
Office for National Statitics. Likelihood of smoking four times higher in England’s most deprived areas then least deprived. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/drugusealcoholandsmoking/articles/likelihoodofsmokingfourtimeshigherinenglandsmostdeprivedareasthanleastdeprived/2018-03-14 . Accessed 25 Nov 2023.
Higgins T, Larson E, Schnall R. Unraveling the meaning of patient engagement: a concept analysis. Patient Educ Couns. 2017;100(1):30–6.
pubmed: 27665500
doi: 10.1016/j.pec.2016.09.002
Petty WJ, Paz-Ares L. Emerging strategies for the treatment of small cell lung Cancer: a review. JAMA Oncol. 2023;9(3):419–29.
pubmed: 36520421
doi: 10.1001/jamaoncol.2022.5631
Li Y, Yan B, He S. Advances and challenges in the treatment of lung cancer. Biomed Pharmacother. 2023;169:115891.
pubmed: 37979378
doi: 10.1016/j.biopha.2023.115891
Lynch C, Harrison S, Butler J, Baldwin DR, Dawkins P, van der Horst J, et al. An International Consensus on actions to improve Lung Cancer Survival: a modified Delphi Method among Clinical experts in the International Cancer Benchmarking Partnership. Cancer Control. 2022;29:10732748221119354.
pubmed: 36269109
pmcid: 9596933
doi: 10.1177/10732748221119354
Davis RE, Jacklin R, Sevdalis N, Vincent CA. Patient involvement in patient safety: what factors influence patient participation and engagement? Health Expect. 2007;10(3):259–67.
pubmed: 17678514
pmcid: 5060404
doi: 10.1111/j.1369-7625.2007.00450.x
World Health Organisation. Patient Engagement: Technical Series on Safer Primary Care. https://iris.who.int/bitstream/handle/10665/252269/9789241511629-eng.pdf?sequence=1 Accessed 20 Nov 2023.
Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42.
pubmed: 21513547
pmcid: 3096582
doi: 10.1186/1748-5908-6-42
United Kingdom Lung Cancer Coalition. Pathways Matter: A review of the implementation of the national optimal lung cancer pathway. https://www.uklcc.org.uk/sites/default/files/2021-06/UKLCC-Pathways-Matter-Report.pdf . Accessed 20 Nov 2023.
Health Education England. Care Navigation: A Competency Framework. 2016. https://www.hee.nhs.uk/sites/default/files/documents/Care%20Navigation%20Competency%20Framework_Final.pdf . Accessed 27 Dec 2023.
Bird W. Improving health in coastal communities. BMJ. 2021;374:n2214.
pubmed: 34535467
doi: 10.1136/bmj.n2214
Philip L, Williams F. Remote rural home based businesses and digital inequalities: understanding needs and expectations in a digitally underserved community. J Rural Stud. 2019;68:306–18.
doi: 10.1016/j.jrurstud.2018.09.011
Witty C. Chief Medical Officer’s annual report 2021: Health in coastal communities. https://assets.publishing.service.gov.uk/media/60f98750e90e0703bbd94a41/cmo-annual_report-2021-health-in-coastal-communities-accessible.pdf . 2021. Accessed 10 Nov 2023.
Witty C. Chief Medical Officer’s annual report 2023: Health in an ageing society. https://assets.publishing.service.gov.uk/media/65562ff2d03a8d000d07faa6/chief-medical-officers-annual-report-2023-web-accessible.pdf . 2023. Accessed 10 Nov 2023.
Department for Environment Food & Rural Affairs: Delivering for rural England - the second report on rural proofing. 2022. https://assets.publishing.service.gov.uk/media/6312001de90e077b73f776d7/Delivering_for_rural_England_-_the_second_rural_proofing_report.pdf . Accessed 27 December 2023.
Todd A, Copeland A, Husband A, Kasim A, Bambra C. Access all areas? An area-level analysis of accessibility to general practice and community pharmacy services in England by urbanity and social deprivation. BMJ Open. 2015;5(5):e007328.
pubmed: 25956762
pmcid: 4431167
doi: 10.1136/bmjopen-2014-007328
Feng X, Feng Z, Astell-Burt T. Perceived public transport infrastructure modifies the association between public transport use and mental health: multilevel analyses from the United Kingdom. PLoS ONE. 2017;12(8):e0180081.
pubmed: 28813422
pmcid: 5558919
doi: 10.1371/journal.pone.0180081
McPeake K, Jeanes L, Nelson D, Selby P, Cooke S, Gussy M, et al. Developing a ‘Living with Cancer’ programme in a rural and coastal setting: experiences of collaborative and innovative co-production across an Integrated Health System. J Cancer Policy. 2023;38:100452.
pubmed: 37931888
doi: 10.1016/j.jcpo.2023.100452
Charter L, Scully R, Laidlaw A. The word that comes to mind is polymath’: medical students’ perceptions of rural postgraduate careers. Rural Remote Health. 2021;21(3):6750.
pubmed: 34412505
Maclaren AS, Locock L, Skea Z. Valuing place in doctors’ decisions to work in remote and rural locations. Future Healthc J. 2022;9(3):248–51.
pubmed: 36561806
pmcid: 9761459
Ministry of Housing Communities & Local Government. The English Indices of Deprivation 2019 (IoD2019). 2019. https://assets.publishing.service.gov.uk/media/5d8e26f6ed915d5570c6cc55/IoD2019_Statistical_Release.pdf . Accessed 11 Nov 2023.
Fecht D, Fortunato L, Morley D, Hansell AL, Gulliver J. Associations between urban metrics and mortality rates in England. Environ Health. 2016;15(Suppl 1Suppl 1):34.
pubmed: 26960289
pmcid: 4895780
doi: 10.1186/s12940-016-0106-3
Department for Environment Food & Rural Affairs. Key Findings, Statistical digest of rural England. 2024. https://www.gov.uk/government/statistics/key-findings-statistical-digest-of-rural-england/key-findings-statistical-digest-of-rural-england . Accessed 12 Nov 2023.
Kelly FJ, Fussell JC. Air pollution and public health: emerging hazards and improved understanding of risk. Environ Geochem Health. 2015;37(4):631–49.
pubmed: 26040976
pmcid: 4516868
doi: 10.1007/s10653-015-9720-1
Public Health England. Improving access to greenspace: A new review for 2020. 2020. https://assets.publishing.service.gov.uk/media/5f202e0de90e071a5a924316/Improving_access_to_greenspace_2020_review.pdf . Accessed 13 Nov 2023.
Nijman J, Wei YD. Urban inequalities in the 21st century economy. Appl Geogr. 2020;117:102188.
pubmed: 32287517
pmcid: 7124478
doi: 10.1016/j.apgeog.2020.102188
O’Dowd EL, Merriel SWD, Cheng VWT, Khan S, Howells LM, Gopal DP, et al. Clinical trials in cancer screening, prevention and early diagnosis (SPED): a systematic mapping review. BMC Cancer. 2023;23(1):820.
pubmed: 37667231
pmcid: 10476302
doi: 10.1186/s12885-023-11300-8
Nelson D, Selby P, Kane R, Harding-Bell A, Kenny A, McPeake K, et al. Implementing the European code of cancer practice in rural settings. J Cancer Policy. 2024;39:100465.
pubmed: 38184144
doi: 10.1016/j.jcpo.2023.100465
Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, et al. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ. 2021;374:n2061.
pubmed: 34593508
pmcid: 8482308
doi: 10.1136/bmj.n2061
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.
pubmed: 17872937
doi: 10.1093/intqhc/mzm042
Rocque GB, Williams CP, Miller HD, Azuero A, Wheeler SB, Pisu M, et al. Impact of Travel Time on Health Care costs and Resource Use by Phase of Care for older patients with Cancer. J Clin Oncol. 2019;37(22):1935–45.
pubmed: 31184952
pmcid: 6804875
doi: 10.1200/JCO.19.00175
Kaushik V, Walsh CA. Pragmatism as a Research Paradigm and its implications for Social Work Research. Social Sci. 2019;8(9):255.
doi: 10.3390/socsci8090255
Patton M. Qualitative Research and Evaluation Methods, 3rd Edition edn: Thousand Oaks: Sage Publications; 2002.
Benoot C, Hannes K, Bilsen J. The use of purposeful sampling in a qualitative evidence synthesis: a worked example on sexual adjustment to a cancer trajectory. BMC Med Res Methodol. 2016;16:21.
pubmed: 26891718
pmcid: 4757966
doi: 10.1186/s12874-016-0114-6
Dworkin SL. Sample size policy for qualitative studies using in-depth interviews. Arch Sex Behav. 2012;41(6):1319–20.
pubmed: 22968493
doi: 10.1007/s10508-012-0016-6
Hennink M, Kaiser BN. Sample sizes for saturation in qualitative research: a systematic review of empirical tests. Soc Sci Med. 2022;292:114523.
pubmed: 34785096
doi: 10.1016/j.socscimed.2021.114523
Jenkins EK, Slemon A, Haines-Saah RJ, Oliffe J. A guide to multisite qualitative analysis. Qual Health Res. 2018;28(12):1969–77.
pubmed: 30024317
doi: 10.1177/1049732318786703
Philbin MM, Parish CL, Kinnard EN, Reed SE, Kerrigan D, Alcaide ML, Cohen MH, Sosanya O, Sheth AN, Adimora AA, Cocohoba J. Multisite study of women living with HIV’s perceived barriers to, and interest in, long-acting injectable antiretroviral therapy. JAIDS J Acquir Immune Defic Syndr. 2020;84(3):263–70.
pubmed: 32530905
doi: 10.1097/QAI.0000000000002337
Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by Information Power. Qual Health Res. 2016;26(13):1753–60.
pubmed: 26613970
doi: 10.1177/1049732315617444
Bergen N, Labonté R. Everything is perfect, and we have no problems: detecting and limiting Social Desirability Bias in qualitative research. Qual Health Res. 2020;30(5):783–92.
pubmed: 31830860
doi: 10.1177/1049732319889354
Morgan DL, Ataie J, Carder P, Hoffman K. Introducing dyadic interviews as a method for collecting qualitative data. Qual Health Res. 2013;23(9):1276–84.
pubmed: 23925406
doi: 10.1177/1049732313501889
Ritchie J, Spencer L, Bryman A, Burgess RG. Analysing qualitative data. In.: Routledge, London; 1994.
Berger R. Now I see it, now I don’t: researcher’s position and reflexivity in qualitative research. Qualitative Res. 2015;15(2):219–34.
doi: 10.1177/1468794112468475
Dodgson JE. Reflexivity in qualitative research. J Hum Lactation. 2019;35(2):220–2.
doi: 10.1177/0890334419830990
Levit LA, Byatt L, Lyss AP, Paskett ED, Levit K, Kirkwood K, et al. Closing the Rural Cancer Care Gap: three institutional approaches. JCO Oncol Pract. 2020;16(7):422–30.
pubmed: 32574128
doi: 10.1200/OP.20.00174
Cancer Research UK. Making Discoveries. Driving Progress. Bringing Hope. Our Research Strategy. 2022. https://www.cancerresearchuk.org/sites/default/files/cancer_research_uk_-_our_research_strategy.pdf . Accessed 22 Nov 2023.
Ali N, Nelson D, McInnerney D, Quaife SL, Laparidou D, Selby P, et al. A systematic review on the qualitative experiences of people living with lung cancer in rural areas. Support Care Cancer. 2024;32(3):144.
pubmed: 38316704
pmcid: 10844412
doi: 10.1007/s00520-024-08342-4
Brice SN, Harper P, Crosby T, Gartner D, Arruda E, England T, et al. Factors influencing the delivery of cancer pathways: a summary of the literature. J Health Organ Manag. 2021;35(9):121–39.
pubmed: 33818048
pmcid: 9136872
doi: 10.1108/JHOM-05-2020-0192
O’Cathain A, Croot L, Duncan E, Rousseau N, Sworn K, Turner KM, et al. Guidance on how to develop complex interventions to improve health and healthcare. BMJ Open. 2019;9(8):e029954.
pubmed: 31420394
pmcid: 6701588
doi: 10.1136/bmjopen-2019-029954