Qualitative assessment of organizational barriers to optimal lung cancer care in a community hospital setting in the United States
Background Lung cancer is a major public health challenge in the United States with a complicated process of care delivery. In addition, it is a challenge for many lung cancer patients and their caregivers to navigate health care systems while coping with the disease.
Objective To explore the organizational barriers to receiving quality health care from the perspective of lung cancer patients and their caregivers.
Methods In a qualitative study involving 10 focus groups of patients and their caregivers, we recorded and transcribed guided discussions for analysis by using Dedoose software to investigate recurrent themes.
Results Analysis of the transcriptions revealed 4 recurring themes related to organizational barriers to quality care: insurance, scheduling, communication, and knowledge. The participants perceived support with navigating the health care system, either through their own social network or from within the health care systems, as beneficial in coping with the lung cancer, seeking information, expediting appointments, connecting patients to physicians, and receiving timely care.
Limitations Institutional and geographic differences in the experience of lung cancer care may limit the generalizability of the results of this study.
Conclusions This study offers insights into the perspectives of lung cancer patients and caregivers on the organizational barriers to receiving quality care. Targeting barriers related to insurance coverage, appointment scheduling, provider-patient communication, and patient or family education about lung cancer and its treatment process will likely improve patient and caregiver experience of care.
Funding Partially funded through a Patient-Centered Outcomes Research Institute Award (IH-1304-6147).
Accepted for publication March 2, 2018
Correspondence Raymond U Osarogiagbon, MBBS; rosarogi@bmhcc.org
Disclosures The authors report no disclosures/conflicts of interest.
Citation JCSO 2018;16(2):e89-e96.
©2018 Frontline Medical Communications
doi https://doi.org/10.12788/jcso.0394
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Limitations
This study has several limitations. Less than half of those approached for the study participated in the study for various reasons, which may have introduced selection bias in terms of not having the perspectives of patients not willing or able to participate in the study. Though focus groups are known to generate rich in-depth views of certain issues, they have been criticized as potentially lacking rigor and generalizability. To address this concern, we used a standardized script for each focus group and involved multiple members of the research team in data analysis and interpretation. Also, this study enrolled participants from a single health care institution and did not use a comparison group. There might be institutional and geographic differences in the experience of lung cancer care, which might further limit the generalizability of the results of this study.
Conclusions
Despite those limitations, this study offers valuable insight into the barriers that lung cancer patients and caregivers encounter while navigating a community-level health care system. Eliminating or minimizing these barriers will require strategic plans that help mitigate insurance-related, scheduling, provider-patient communication, and patient/caregiver knowledge acquisition problems and translate them into tactical actions for quality improvement. This is one of the first qualitative studies conducted to understand the organizational barriers that lung cancer patients and their caregivers face within a health care system. Additional research is needed to explore these barriers and develop viable solutions.
,Disclaimer
All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute or its Board of Governors or Methodology Committee.
