Patient-perceived barriers and facilitators for risk-stratified follow-up care in lung cancer: a qualitative study

The shortage of healthcare professionals alongside the rising number of lung cancer survivors poses a significant challenge to current healthcare facilities. Risk-stratified follow-up care, with tailored diagnostic imaging and follow-up intervals based on a patients' risk of recurrence, may improve clinical outcomes and help address this challenge. Our study is aimed at identifying patient-perceived barriers and facilitators for implementing this approach.

A qualitative study was performed including 15 semi-structured interviews and three focus groups (n = 16) among lung cancer patients who completed treatment and currently receive follow-up care. Inductive and axial coding of the transcripts was performed to categorize codes into barriers and facilitators at six different levels using the Grol and Wensing framework.

Most barriers were identified at the organizational, economic, and political levels when shortening follow-up intervals and altering the imaging modalities due to limited available personnel, restricted imaging logistics, and financial resources. At the patient level, the most important barrier is fear of recurrence when extending follow-up intervals. Facilitators at the organizational level involved providing a direct point of contact and supportive care during risk-stratified follow-up. Overall, patients are willing to adopt risk-stratified follow-up care when sufficient evidence for its effectiveness is provided.

We found most of the barriers, facilitators, and preferences at the organizational, economic, political, and patient level. The identified barriers and facilitators in this study can serve as a base for a strategy to implement a risk-stratified follow-up care in lung cancer care if effectiveness can be proven.