Multilevel factors associated with timeliness of care along the lung cancer care continuum - A systematic review.

BACKGROUND: Factors affecting time to lung cancer care may occur at multiple levels of influence. OBJECTIVE: The study aimed to identify multilevel factors associated with delays in lung cancer care. METHODS: Following Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines, Medline (PubMed), CINAHL, and SCOPUS were searched using validated search terms for lung cancer and factors, health disparities and time/delay. Eligible studies included original articles with quantitative, qualitative, or mixed-methods designs that investigated health disparities in, risk factors for, or barriers to timely screening, confirmatory diagnosis, or treatment among patients with lung cancer or those at risk for lung cancer. Title/abstract (TIAB), and full-text screening, study quality assessment (QA), and data extraction were conducted by 2 reviewers. RESULTS: 13,068, 2608, and 424 TIAB were identified from PubMed, CINAHL, and SCOPUS, respectively. After deduplication, 14,405 articles were screened and 74 full-texts were assessed. Fifteen studies (all quantitative) were selected for QA and data extracted. Based on the National Institutes of Health QA tool, 5, 6, and 4 studies were rated good, fair, and poor, respectively. Multilevel factors associated with diagnosis to treatment interval were: Patient (demographic - age, sex, race/ethnicity, marital status, region, health insurance; disease - comorbidity, lung cancer type, stage, tumor size, brain metastasis, and treatment), clinic setting (facility type), environmental (income, poverty, hospital supply, and subspecialist supply). Other intervals assessed include: screening to diagnosis, symptom to initial primary care provider visit, suspicious image to diagnostics, suspicious image to diagnosis, suspicious image to surgical referral, and surgical referral to surgery. CONCLUSION: We did not identify any qualitative or mixed-methods study. The quality of the included quantitative were fair-good. Qualitative and mixed-methods studies on the timeliness of lung cancer care are recommended to provide context on multilevel factors. The identified multilevel factors will help in intervention planning to select intervention components that address gaps in the timeliness of lung cancer care.