Closing the equity gap in access to early lung cancer diagnosis in Aotearoa: key informant perspectives and recommendations for action
Virginia Signal
1 * , Moira Smith 2 , Laird Cameron 3 4 , Shaun Costello 5 , Paul Dawkins 6 7 , Jonathan Koea 8 , Ross Lawrenson 9 , Catherine Smith 10 , Jason Gurney 2
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Abstract
Lung cancer survival is worse for Māori in Aotearoa New Zealand (NZ) than non-Māori. Our previous work identified that Māori are more likely to have their lung cancer diagnosed following an emergency presentation and face additional barriers in accessing secondary diagnostic services.
To inform improvements in lung cancer services, we aimed to collect key informant views on the extent to which these disparities were modifiable and how they might be modified by the healthcare system.
We interviewed 18 key informants from across the cancer sector, including clinicians, academics, policy experts, community workers and advocates. Analysis of collected views was conducted utilising a previously published conceptual framework to help organise and describe key issues and recommended actions.
Key themes emerging from the interviews included the value of lung cancer screening; the importance of health promotion; the need for an overhaul to primary care to improve access to clinical symptom recognition and early detection; the importance of improving geographic access to diagnostic/secondary services; the need to ensure the expansion of and improvements in a culturally-safe and competent workforce; the value and importance of good data to enable quality improvement; and the crucial importance of high-quality leadership and political buy-in.
Our interviews revealed some of the potential drivers of barriers to early detection experienced by Māori and the recommendations for action to address these barriers. The majority of these recommendations require system-level resourcing and change.
Keywords: early detection, health equity, health systems, lung cancer, Māori health, primary care, policy, race and ethnicity.
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