Hospital Trust Research Articles

Morphologic Characterization of Pancreatic Ductal Adenocarcinoma following Post-neoadjuvant Pancreatectomy and Clinical value of Intratumor Heterogeneity.

To evaluate the morphologic landscape of pancreatic ductal adenocarcinoma (PDAC), intratumor spatial heterogeneity, and the resulting clinical impact following post-neoadjuvant pancreatectomy. The clinical value of PDAC morphologic subtypes and intratumor spatial heterogeneity post-treatment remains an open issue. The study cohort included patients who underwent post-neoadjuvant pancreatectomy for PDAC at the University of Verona Hospital Trust between 2013 and 2019. All hematoxylin and eosin-stained slides were reviewed to assess PDAC histomorphology and intratumor heterogeneity. The relationship with other clinicopathological variables, overall survival (OS), and recurrence-free (RFS) survival was evaluated using standard statistics. The study cohort included 400 patients. Histological revision identified ten different morphologic subtypes. Gland-forming PDAC with a conventional pattern was the most frequently identified subtype (41.8%). Overall, 247 tumors (61.7%) showed only one histological pattern and were classified as homogeneous, whereas 153 (38.3%) showed different morphologies and were classified as heterogeneous tumors. The median post-resection survival was 30.1 months (95%CI 26.6-33.5). There was a substantial survival variability according to the morphologic subtype, ranging from 19.1 months in the gyriform subtype to 47.0 months in the papillary subtype. Tumors with a heterogeneous morphology displayed a higher rate of nodal metastases, worse tumor regression metrics, and worse oncologic outcomes relative to spatially homogeneous tumors. This paper provided a morphological taxonomy of residual tumors following post-neoadjuvant pancreatectomy for PDAC. The morphologic subtype and intratumor spatial heterogeneity have relevant prognostic implications and could be included in the pathology report to complement regression metrics.

Factors behind favorable long-term lung cancer survival in Norway compared to Denmark: a retrospective cohort study

ABSTRACT Background Long-term survival of patients with non-small cell lung cancer (NSCLC) is considerably higher in Norway compared to Denmark, even though diagnostic work-up, treatment, and follow-up are comparable. We aim to explore factors behind favorable long-term survival for lung cancer patients in Norway compared to Denmark. Method A retrospective cohort study of patients with NSCLC diagnosed between 2014 and 2016. From the Danish Lung Cancer Registry, 1000 patients were randomly selected, and 974 patients were included. From the Norwegian Vestfold Hospital Trust, 220 patients were randomly selected, and 218 were included. Data from medical records were obtained for all patients. The Danish and Norwegian cohorts were compared using the Pearson chi squared test and multivariate logistic regression analysis. Results The two cohorts were comparable in terms of age, sex, and smoking history. However, the Danish patients had a higher number of pack-years (43.5 vs 34.5 p < 0.001) and more comorbidities. The Norwegian patients had less advanced disease stage (p < 0.001), and a larger proportion was treated with curative intent (90 (41.3%) vs 343 (35.2%), p = 0.063). One-year survival was similar, but the 5-year survival was superior in the Norwegian cohort (58 (26.6%) vs 177 (18.2%), p = 0.005). In a multivariate logistic regression model, adjusted for sex, smoking history, performance status, TNM stage and comorbidity, the odds ratio of being a five-year survivor in Norway was 1.81 (95% CI: 1.11–2.94) compared to Denmark. Conclusions We found a higher proportion of Norwegian patients diagnosed at potential curable stage and fewer heavy smokers compared to Danish patients. This could contribute to the superior long-term survival found in Norwegian NSCLC patients.

The Maternity Engagement Project

Helen Peck discusses the Twins Trust project to improve care for women pregnant with multiples in a Lincolnshire hospital trust

Outcomes for centenarian patients admitted with orthopaedic trauma

IntroductionThe United Kingdom (UK) and world's population is aging with patients living longer, often with many co-morbidities. It is expected that patients of extreme old age would have poor outcomes following trauma; however, this assumption is not clearly evidenced. This study aims to present the outcomes of patients aged 100 or older admitted to a single hospital trust following admission for orthopaedic trauma. MethodA prospective cohort of patients aged 100 years and over admitted to the trauma and orthopaedic departments of two hospitals within the same trust between 2008 and 2022 was reviewed. Age was median 101 years (100–106 years). Outcome measures were length of stay, survival, complications and change in accommodation. Results80 patients met the inclusion criteria (71female, 9 male). Mean age at discharge was 102.5 years with survival mean 4.2 years. 2 patients with peri-prosthetic fracture survived a further 5 years. Mean length of stay was 17 days. 57 patients returned to their original place of residence. 72 patients (90 %) survived the acute hospital admission. ConclusionSurvival rates for patients aged over 100 years were high and most returned to the previous place of residence. This study supports the surgical management of trauma and helps inform patients and families expectations for mortality risk.

Improving the assessment of cultural, religious and spiritual needs for patients at the end-of-life within an acute hospital trust

BackgroundCultural, religious and spiritual (CRS) needs become increasingly important to individuals as they approach the end of life. CRS needs often remain unmet for patients dying in an acute hospital...

Measurement of Self-Efficacy in Pregnant Females with Low Back Pain

Background: Self-efficacy, the belief in one's ability to accomplish tasks, plays a crucial role in managing pain. Low back pain (LBP) is a common issue during pregnancy, significantly affecting daily life. This study aimed to assess the relationship between self-efficacy and pain severity in pregnant women with LBP.Objective: To measure self-efficacy and determine its association with pain severity in pregnant females suffering from LBP.Methods: A cross-sectional study was conducted from July to December 2023 at Akhtar Saeed Trust Hospital, Lahore. A total of 87 pregnant women with LBP were recruited using non-probability convenience sampling. Self-efficacy was measured using the General Self-Efficacy Scale, and pain severity was assessed using the Visual Analogue Scale. Data were analyzed using SPSS version 25, with descriptive statistics and chi-square tests used to explore associations.Results: The mean age of participants was 30.51 ± 3.72 years. Moderate pain was reported by 86.2% of participants, while 43.7% had high self-efficacy. A significant association was found between self-efficacy and pain severity (p = 0.028).Conclusion: Higher self-efficacy was significantly associated with lower pain severity in pregnant women with LBP, suggesting the importance of self-efficacy in pain management.

Patients' intention to make an up-front payment at private outpatient clinics in Malaysia as a no-show reduction method.

Regulating patients' no-show behavior is critical from the standpoints of sustainable medical services and operational efficiencies. The purpose of this study was to evaluate the patients' intention to make partial up-front payments at outpatient clinics. This was a cross-sectional study design introducing a self-administered questionnaire to 221 outpatients at a private health facility. The questionnaire measured the patient's demographic characteristics, perceived usefulness (PU), trust in the health facility, and intention to make upfront partial payments. Out of the total respondents, 57.4% were female. There were 34.8% Malays, 40.6% Chinese and 24.6% Indians. The majority (66.5%) of the respondents attained tertiary education. Nearly a third of the respondents (30.5%) reported an income between 3000 and 5000 Malaysian Ringgit (RM). Regarding payment mode, just more than half (51.1%) made self-payment, and 21.8% by guaranteed letter. A quarter (24.9%) waited more than 3h for consultation and 59.6% visited the health facility more than 2 times in a year.Initial analysis showed that PU, trust, age, education, number of visits, and hours of waiting were significantly associated with the intention to make a partial payment. Multiple linear regression showed that perceived usefulness (B = 0.517, p < 0.001); trust in hospital management (B = 0.288, p < 0.001) and number of visits (B = 0.216, p < 0.001) were associated with the intention to make partial payment.Intention to make partial up-front payments is associated with higher perceived usefulness in making such payments and hospital trust. Visiting the health facility frequently was associated with a higher intention to make upfront partial payment. The result may guide further studies on potential remedies to no-show.

Prehospital Management of Postpartum Hemorrhage-A National, Cross-Sectional Study in Norway.

Postpartum hemorrhage (PPH) is a critical birth complication, and is stated by the World Health Organization (WHO) as among the five most frequent causes of death during pregnancy. External aortic compression (EAC) is recommended by the WHO as an intervention to achieve temporary bleeding control. An increasing number of births outside hospital underlines the importance of competence in handling potential birth complications, such as PPH. The aim of this study was to assess prehospital personnel's education, training, knowledge, and experiences regarding PPH and EAC across Norway. Prehospital personnel were invited to respond to a questionnaire through social media. Questions included those on education, training, knowledge, and experience regarding PPH and EAC. The Statistical Package for the Social Sciences (SPSS) version 28 was used to analyze the data, using descriptive statistics. Over a two-month period, 211 prehospital personnel responded to the questionnaire, of whom 55.5% were male. The respondents had an average of 10.3 years of prehospital experience. About half of the respondents had received education (48.6%) and training (62.4%) in PPH management. Still, 95.7 percent reported a need for more education and training. On knowledge questions, only half of the responses were correct (43.7% to 60.5%). Only 21 percent of the respondents had experienced patients with PPH, and of these only 3.8 percent had used EAC. Bimanual uterine compression was the most frequent intervention used (62.5%) across hospital trusts. Even if prehospital personnel receive education and training in the management of PPH and EAC, almost all report needing more. The results indicate a national variation, which may be discussed as to whether it is appropriate.

A Patient and Public Engagement Project to Inform Dementia Care in a UK Hospital Trust.

The increasing prevalence of dementia in the United Kingdom presents significant challenges for healthcare, with projections estimating over a million affected individuals by 2025, costing the NHS £6.3 billion annually. Hospital admissions among dementia patients are common, occupying about 25% of UK hospital beds and leading to prolonged stays and diminished health outcomes. This paper presents the opening stages, part of a larger project where Patient and Public Involvement and Engagement (PPIE) was employed to understand and navigate what it means for hospital care for a person living with dementia. To understand hospital care for dementia patients, focus groups were conducted through dementia cafés in Essex and Suffolk from February to July 2023 engaging patients, carers and family members. Recognised processes for reporting PPIE and thematic analysis were used and identified six themes and 21 subthemes regarding hospital care: individualised care, role of carers, basic care, interpersonal communication, information sharing and staffing. The results from the PPIE will be used to inform and work with stakeholders through the next phases of the project, which involves examining care processes in the hospital, identifying touchpoints and evaluating these areas. The project continues to be informed by stakeholders including people living with dementia, carers and staff. Additionally, the results may inform other service providers for care enhancements, processes and delivery. Moving forward, the study emphasises the importance of building collaborative relationships with stakeholders involved in dementia care. Additionally, it provides insights to focus areas that are fundamental for acute care organisations when delivering care to people living with dementia. By incorporating insights from PPIE, this project seeks to identify inequalities in dementia care services, improve hospital care for people living with dementia, fostering a more inclusive and supportive healthcare environment. The purpose of the study was to explore the most important issues around hospital care for people with dementia, their carers and families. Persons living with dementia, carers and family members were involved in the study through community dementia cafés and recruited to take part in focus groups to discuss hospital care for patients with dementia. The design of questions and materials for the discussions was developed through consultation with the university department's service user lead and dementia specialist and reviewed by a service user member living with dementia. A pilot focus group was conducted with a group of carers. We worked with the dementia café managers to coordinate recruitment and a suitable environment to run the focus groups. Not applicable.

FP1.12 - How many Colorectal cancer patients had negative Faecal Immunochemical Testing (FIT) within the previous 1 year?

Abstract Introduction Colorectal cancer (CRC) accounts for approximately 10% of all cancer diagnoses and 9.4% of all cancer deaths worldwide. Since its introduction, quantitative faecal immunochemical testing (qFIT) has become a vital tool in bowel cancer screening and triaging of symptomatic patients. Our trust has seen a 20% increase in lower gastrointestinal referrals over a 12-month period. The aim of this investigation was to identify how many patients with a negative qFIT were diagnosed with CRC within 12 months and if there is potential to downgrade referrals with negative qFIT. Methods This retrospective study reviewed new CRC diagnoses in one hospital trust, diagnosed from January to December 2022, who were referred as symptomatic red flag referrals. All patients in this timeframe had records reviewed for qFIT performed within the 12 months prior to their diagnosis. A negative qFIT test was defined as lab result of &amp;lt;7ugHb/g. Results Two hundred and forty-seven patients were diagnosed with CRC from January to December 2022. One hundred and three patients did not have a documented qFIT within the timeframe and therefore were excluded from analysis. One hundred and forty-four cases were further reviewed, of which 14 (9.7%) had a negative qFIT within the 12 months before diagnosis. Conclusions This audit does not support the downgrading of Red Flag referrals based on a negative qFIT result. Further analysis is needed to ascertain how best to triage symptomatic referrals for colorectal cancer with a negative qFIT to help cope with an increasing burden of Red Flag referrals.

Impact of robotic-assisted surgery on length of hospital stay in Paris public hospitals: a retrospective analysis

The number of available hospital beds is decreasing in many countries. Reducing the length of hospital stay (LOS) and increasing bed turnover could improve patient flow. We evaluated whether robot-assisted surgery (RAS) had a beneficial impact on the LOS in a French hospital trust with a long-established robotic program (Assistance Publique–Hôpitaux de Paris, AP-HP). We extracted data from “Programme de Médicalisation des Systèmes d’Information” to determine the median LOS for adults in our trust after RAS versus laparoscopy and open surgery in 2021–2022 for eight target procedures, and compared data nationally and at similar academic centres (same database). We also calculated the number of hospitalisation days ‘saved’ using RAS. Overall, 9326 target procedures were performed at AP-HP: 3864 (41.4%) RAS, 2978 (31.9%) laparoscopies, and 2484 (26.6%) open surgeries. The median LOS for RAS was lower than laparoscopy and open surgery for all procedures, apart from hysterectomy and colectomy (equivalent to laparoscopy). Results for urological procedures at AP-HP reflected national values. The equivalent of 5390 hospitalisation days was saved in 2021–2022 using RAS instead of open surgery or laparoscopy at AP-HP; of these, 86% represented hospitalisation days saved using RAS in urological procedures. Using RAS instead of open surgery or laparoscopy (particularly in urological procedures) reduced the median LOS and may save thousands of hospitalisation days every year. This should help to increase patient turnover and facilitate patient flow.

Value of Ultrasonography in Assessment of Screen-Detected Calcified Ductal Carcinoma In Situ: A Clinical Audit

Abstract Background: Approximately 80% of ductal carcinoma in situ (DCIS) cases are asymptomatic and manifest as microcalcifications, usually detected on screening mammograms. Stereotactic biopsy is used as the primary modality for histopathologic diagnosis. Ultrasonography has been relied upon as a potentially viable alternative for early breast cancer detection, especially in low- and medium-income countries. Aim: Determine the role and reliability of breast ultrasonography in the evaluation of screen-detected microcalcifications using histologically proven calcified DCIS as a case study. Materials and Methods: Cross-sectional evaluation of records of patients recalled for M3–M5 (indeterminate to malignant) type microcalcifications on screening mammograms, with a histological diagnosis of pure DCIS, in an NHS Trust Hospital, Kent, England, from March 2021 to April 2023. Results: Eighty women included were within the age range of 46–79 years, with mean age of 60 years. Background breast density was predominantly fatty in 51/80 (63.8%), without any correlation with mammographic abnormalities. Microcalcifications were classified as indeterminate (M3) in 42/80 (52.5%), while suspicious (M4) and malignant (M5) types were seen in 38/80 (47.5%). No targeted sonographic abnormalities were noted in 69 (86.2%) of the patients, while 11 (13.8%) had sonographic abnormalities. The predominant sonographic feature was non-mass hypoechogenicity in 6/11(55%). There was a correlation between mammographic code, lesion size, and ultrasonic abnormality, with 9/11 (81.8%) patients with sonographic lesions having suspicious and malignant type calcifications. The mean mammographic lesion size was significantly greater in women with abnormal ultrasound findings, 42 vs. 20 mm. Histological tumour grade was high grade in 10/11 (90.9%) lesions. Conclusion: The accuracy of breast ultrasonography as an adjunct in the detection of screen-detected microcalcifications and subsequent guided biopsy is higher when dealing with malignant type microcalcifications &gt;15 mm in size.

Investigating age and ethnicity as novel high-risk phenotypes in mucinous ovarian cancer: retrospective study in a multi-ethnic population

ObjectivesPrimary mucinous ovarian carcinoma represents 3% of ovarian cancers and is typically diagnosed early, yielding favorable outcomes. This study aims to identify risk factors, focussing on the impact of age...

CN105 Malignant bowel obstruction in advanced cancer: A nurse-led review of symptom management, dietitian involvement and outcomes at two sites of an NHS Hospital Trust

CN105 Malignant bowel obstruction in advanced cancer: A nurse-led review of symptom management, dietitian involvement and outcomes at two sites of an NHS Hospital Trust

Comparison of Prognostic Value of Predictors of Mortality in Patients with Cirrhosis and Refractory Ascites

The Model for End-Stage Liver Disease-Sodium score (MELDNa) has been developed that has a better prognostic value to predict early mortality but has not been frequently used in cirrhotic and refractory ascites patients with recurrent incidences of severe hyponatremia. Objective: To compare the prognostic value of severe hyponatremia, Child-Pugh score, and the model for end-stage liver disease-sodium score in cirrhotic and refractory ascitic patients. Methods: A prospective, observational study was conducted at the Hepatology Department, Bakhtawar Amin Trust Hospital, Multan from March 2023 to March 2024. A total of 200 patients with cirrhosis and refractory ascites undergoing albumin paracentesis twice a month were selected for the study. The 135 patients (after exclusion of preexisting ascites patients) were administered diuretics symmetrically; 50 mg spironolactone and 40 mg furosemide in patients who did not have renal failure and severe hyponatremia. Prognostic scores were recorded and patients were followed up for minimum 3 months. Results: The area under the curve of the Child-Pugh score (0.90, 95% CI: 0.87-0.96) was significantly higher than the MELD score (0.60, 95 CI: 0.51-0.70) and MELDNa (0.75, 95% CI: 0.65-0.79) as a predictor of mortality (p&lt;0.0001). With respect to the etiology of refractory ascites being an independent risk factor of mortality, the cumulative incidence function was highest in patients with hyponatremia (79%; 95% CI: 79-80%) followed by renal failure patients (55%; 95 CI: 54-56%) and patients receiving maximum dose of treatment (28%; 95% CI: 27-29%) (p&lt;0.001). Conclusions: Severe hyponatremia, ineffective diuretic treatment, and Child-Pugh score were risk factors of death in cirrhotic and refractory ascitic patients.

Patient safety during transfers from critical care: developing and assessing a checklist.

Critically ill patients often need to be transferred from the intensive care unit (ICU) to the imaging department. This can compromise their safety, not only because of the inherent risk of deterioration but also because of the potential for incidents due to the inadequate preparation of medicines, equipment and monitoring. Using a patient transfer checklist can reduce the risk of human factor errors. This article reports on a quality improvement project conducted at the ICU of an acute hospital trust in the Midlands to develop and evaluate a patient transfer checklist. The checklist was developed based on guidance from the Intensive Care Society and evaluated using retrospective incident reports, an audit of staff compliance and a user survey. Using a transfer checklist in the ICU is likely to reduce patient safety incidents during transfers, but a shift in workplace culture may be needed to enhance incident reporting.

Nursing Team Composition and Mortality Following Acute Hospital Admission

Many studies show the adverse consequences of insufficient nurse staffing in hospitals, but safe and effective staffing is unlikely to be just about staff numbers. There are considerable areas of uncertainty, including whether temporary staff can safely make up shortfalls in permanent staff and whether using experienced staff can mitigate the effect of staff shortages. To explore the association of the composition of the nursing team with the risk of patient deaths. This patient-level longitudinal observational study was conducted in 185 wards in 4 acute hospital trusts in England between April 2015 and March 2020. Eligible participants were patients with an overnight stay and nursing staff on adult inpatient wards. Data analysis was conducted from month April 2022 to June 2023. Naturally occurring variation during the first 5 days of hospital admission in exposure to days of low staffing from registered nurses (RNs) and nursing support (NS) staff, the proportion of RNs, proportion of senior staff, and proportion of hospital-employed (bank) and agency temporary staff. The primary outcome was death within 30 days of admission. Mixed-effect Cox proportional hazards survival models were used. Data from 626 313 admissions (319 518 aged ≥65 years [51.0%]; 348 464 female [55.6%]) were included. Risk of death was increased when patients were exposed to low staffing from RNs (adjusted hazard ratio [aHR], 1.08; 95% CI 1.07-1.09) and NS staff (aHR, 1.07; 95% CI, 1.06-1.08). A 10% increase in the proportion of temporary RNs was associated with a 2.3% increase in the risk of death, with no difference between agency (aHR, 1.023; 95% CI, 1.01-1.04) and bank staff (aHR, 1.02; 95% CI, 1.01-1.04). A 10% increase in the proportion of agency NS was associated with a 4% increase in risk of death (aHR, 1.04; 95% CI, 1.02-1.06). Evidence on the seniority of staff was mixed. Model coefficients were used to estimate the association of using temporary staff to avoid low staffing and found that risk was reduced but remained elevated compared with baseline. This cohort study found that having senior nurses in the nursing team did not mitigate the adverse outcomes associated with low nurse staffing. These findings indicate that while the benefits of avoiding low staffing may be greater than the harms associated with using temporary staff, particularly for RNs, risk remains elevated if temporary staff are used to fill staffing shortages, which challenges the assumption that temporary staff are a cost-effective long-term solution to maintaining patient safety.

Barriers to the adoption of routine surgical video recording: a mixed-methods qualitative study of a real-world implementation of a video recording platform

BackgroundRoutine surgical video recording has multiple benefits. Video acts as an objective record of the operative record, allows video-based coaching and is integral to the development of digital technologies. Despite these benefits, adoption is not widespread. To date, only questionnaire studies have explored this failure in adoption. This study aims to determine the barriers and provide recommendations for the implementation of routine surgical video recording.Materials and methodsA pre- and post-pilot questionnaire surrounding a real-world implementation of a C-SATS©, an educational recording and surgical analytics platform, was conducted in a university teaching hospital trust. Usage metrics from the pilot study and descriptive analyses of questionnaire responses were used with the non-adoption, abandonment, scale-up, spread, sustainability (NASSS) framework to create topic guides for semi-structured interviews. Transcripts of interviews were evaluated in an inductive thematic analysis.ResultsEngagement with the C-SATS© platform failed to reach consistent levels with only 57 videos uploaded. Three attending surgeons, four surgical residents, one scrub nurse, three patients, one lawyer, and one industry representative were interviewed, all of which perceived value in recording. Barriers of ‘change,’ ‘resource,’ and ‘governance,’ were identified as the main themes. Resistance was centred on patient misinterpretation of videos. Participants believed availability of infrastructure would facilitate adoption but integration into surgical workflow is required. Regulatory uncertainty was centred around anonymity and data ownership.ConclusionBarriers to the adoption of routine surgical video recording exist beyond technological barriers alone. Priorities for implementation include integration recording into the patient record, engaging all stakeholders to ensure buy-in, and formalising consent processes to establish patient trust.

Effect of cancer waiting time standards in the English National Health Service: a threshold analysis

BackgroundThe English National Health Service has multiple waiting time standards relating to cancer diagnosis and treatment. Targets can have unintended effects, such as prioritisation based on targets instead of clinical need. In this case, a `threshold effect’ will appear as a spike in hospitals just meeting the target.MethodsWe conducted a retrospective study of publicly available cancer waiting time data, including a 2-week wait for a specialist appointment, a 31-day decision to first treatment and a 62-day referral to treatment standard that attracted a financial penalty. We examined the performance of hospital trusts against these targets by financial year to look for threshold effects, using Cattaneo et al. manipulation density test.ResultsTrust performance against cancer waiting targets declined over time, and this trend accelerated since the start of the Covid-19 pandemic. Statistical evidence of a threshold effect for the 2-week and 31-day standard was only present in a few years. However, there was strong statistical evidence of a threshold effect for the 62-day standard across all financial years (p < 0.01).ConclusionThe data suggests that the effect of threshold targets alters hospital behaviour at target levels but does not do so equally for all standards. Evidence of threshold effects for the 62-day standard was particularly strong, possibly due to some combination of a smaller volume of eligible patients, a larger penalty, multiple waypoints where hospitals can intervene, baseline performance against the target and where the target is set (i.e. how much headroom is available). RCTs of the use of threshold targets and of different designs for such targets in the future would be extremely informative.

Understanding the impact of distance and disadvantage on lung cancer care and outcomes: a study protocol

BackgroundLung cancer is the third most common cancer in the UK and the leading cause of cancer mortality globally. NHS England guidance for optimum lung cancer care recommends management and treatment by a specialist team, with experts concentrated in one place, providing access to specialised diagnostic and treatment facilities. However, the complex and rapidly evolving diagnostic and treatment pathways for lung cancer, together with workforce limitations, make achieving this challenging. This place-based, behavioural science-informed qualitative study aims to explore how person-related characteristics interact with a person’s location relative to specialist services to impact their engagement with the optimal lung pathway, and to compare and contrast experiences in rural, coastal, and urban communities. This study also aims to generate translatable evidence to inform the evidence-based design of a patient engagement intervention to improve lung cancer patients’ and informal carers’ participation in and experience of the lung cancer care pathway.MethodsA qualitative cross-sectional interview study with people diagnosed with lung cancer < 6 months before recruitment (in receipt of surgery, radical radiotherapy, or living with advanced disease) and their informal carers. Participants will be recruited purposively from Barts Health NHS Trust and United Lincolnshire Hospitals NHS Trusts to ensure a diverse sample across urban and rural settings. Semi-structured interviews will explore factors affecting individuals’ capability, opportunity, and motivation to engage with their recommended diagnostic and treatment pathway. A framework approach, informed by the COM-B model, will be used to thematically analyse facilitators and barriers to patient engagement.DiscussionThe study aligns with the current policy priority to ensure that people with cancer, no matter where they live, can access the best quality treatments and care. The evidence generated will be used to ensure that lung cancer services are developed to meet the needs of rural, coastal, and urban communities. The findings will inform the development of an intervention to support patient engagement with their recommended lung cancer pathway.Protocol registrationThe study received NHS Research Ethics Committee (Ref: 23/SC/0255) and NHS Health Research Authority (IRAS ID 328531) approval on 04/08/2023. The study was prospectively registered on Open Science Framework (16/10/2023; https://osf.io/njq48).