The feasibility and acceptability of novel surveillance models for people with advanced staged lung cancer in Aotearoa. Kia Mataara: staying alert for lung cancer

Background: Lung cancer is the leading cause of cancer death globally. The advanced nature of the disease at diagnosis results in a large proportion of patients entering follow-up programmes. Follow-up protocols are variably defined with no input from patients as to what would work best for them. Instead, protocols stem from ritualistic clinician behaviour rather than any understanding of their impact on survival or patient experiences. Aims: To identify factors that contribute to good follow-up patient experiences and utilise these to build and trial a novel follow-up model. Methods: A narrative review was conducted to identify current evidence around follow-up. Patient’s preferences for follow-up were explored through co-design methods including a discrete choice experiment (DCE), then used to develop a novel model of follow-up. A feasibility randomised controlled trial (RCT) was undertaken to test the new web-based model. Healthcare providers (HCPs) were interviewed to identify barriers and enablers to implementing novel follow-up protocols. Patient’s experiences of telehealth cancer care during COVID-19 were captured through interviews. Results: Current follow-up is based on expert opinion with little consideration of patient preferences, quality of life, impact on anxiety, and impact on survival outcomes. Findings from the co-design phases identified the importance of relationship, consistency, and convenience of follow-up for patients. The RCT was considered feasible as > 70% of patients completed all interventions and outcome measures. The retention rate for the RCT was 89%. The RCT was considered acceptable by participants in both arms, and by the clinicians across the lung cancer team. HCPs identified costs and poor communication impacted on how care was delivered. Access to imaging and challenges for patients such as internet services were barriers to implementing a novel model of follow-up. Conclusion: The feasibility RCT successfully evaluated the novel protocol identifying issues that may hinder the success of a larger RCT. The novel model of care was found to be acceptable, safe, and complementary to the current model of follow-up. Māori HCPs identified the importance of co-design in future development of models to ensure they were flexible for communities to access care and stay connected to their oncology team.

Name thesis:degree_name

PhD

Level thesis:degree_level

Doctoral

Discipline thesis:degree_discipline

Population Health

Grantor dc:publisher

ResearchSpace@Auckland

Year dc:date.issued

2025

Author dc:creator

• Fraser, Sarah Anne

Advisors dc:contributor.advisor

• Mc Neill, Rob
• Robinson, Jackie

Statement dc:rights

• Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Licence dc:rights.uri

• https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm

Handle dc:identifier.uri

https://hdl.handle.net/2292/71698

OAI identifier oai:identifier

oai:researchspace.auckland.ac.nz:2292/71698