Table 1.

Study characteristics

Study (country)	Population	Methods/design	Key findings
Crawford-Wiliams et al. [30] (2022) Australia Aim: To understand how cancer survivors in rural Queensland seek and receive information as well as their preferences regarding content and delivery of health-related information	Cancer patients n = 24 (lung cancer n = 6) Mean age = 63.8 years M/F = 11/13 Queensland, Australia Inner regional n = 9 Outer regional n = 9 Remote/very remote n = 6	Qualitative descriptive design using semi-structured interviews Reflective thematic analysis Postcodes geocoded and classified by remoteness of area according ASGS classification	Participants reported that health-related information provision was inconsistent and occasionally contradictory. Cancer survivors’ needs for information and attitudes towards seeking it varied greatly and many survivors had difficulty processing and retaining information due to emotional distress
Drury and Inma [31] (2010) Australia Aim: To explore patients’ experiences from perspectives of patients and healthcare providers in a regional area of Western Australia	Cancer patients n = 11 (lung cancer n = 2) Cancer nurse n = 1 Cancer support worker n = 3 Cancer educator n = 1 Age range = 40 to > 60 years M/F = 6/5 Regional Western Australia	Qualitative design using semi-structured interviews Thematic analysis used in an action research framework	Patients who had the involvement of a cancer nurse coordinator and cancer support workers reported better experiences and more streamlined care than did those who had to navigate the journey alone. It was suggested by most participants that metropolitan health professionals had little empathy or understanding of the travelling involved for rural patients
Emery et al. [32] (2013) Australia Aim: To compare and explore symptom appraisal and help-seeking behavior in patients with breast, lung, prostate, or colorectal cancer from rural Western Australia	Cancer patients n = 66 (lung cancer n = 8) Mean age = 60.5 years M/F = 28/38 Rural Western Australia	Mixed method design Qualitative data collected using semi-structured interviews Thematic framework analysis Rurality defined using ARIA	Differences were observed in symptom appraisal and help-seeking behaviors between patients with breast, lung, prostate, or colorectal cancer. Lung cancer patients reported being shocked with their lung cancer diagnosis and cited factors related to distance and stoicism that influenced longer symptom appraisal and help-seeking intervals
Hall et al. [33] (2008) Australia Aim: To investigate if the pattern of diagnostic testing for suspected lung cancer, stage at diagnosis, patterns of specialist referral, and treatment options offered to people in rural Western Australia are similar to those in the metropolitan area. To explore the barriers to quality care in rural areas as perceived by GPs and patients	Lung cancer patients n = 43 General practitioners n = 27 Mean age = 63.53 M/F = 26/17 Western Australia Rural n = 22 Metropolitan n = 21	Mixed method design Qualitative data collected using semi-structured interviews Interviews collected in n = 14 lung cancer patients only Grounded theory inductive analysis approach Rurality defined using ARIA	Rural patients perceived their symptoms as minor rather than cause to see their GPs. Only a quarter of rural patients expressed trust in their healthcare professionals. The quality of psychological care was an issue for rural patients. Rural patients were also less satisfied with aspects of their care, especially with the quality of communication, and some rural patients also expressed concerns about financial aspects of their care
Kidd et al. [34] (2021) New Zealand Aim: To explore the barriers to early presentation and diagnosis of lung cancer, as identified by Māori patients, whanau (families), and primary healthcare providers in Midland region of New Zealand	Community participants (lung cancer patients, family members and other community members) Healthcare providers (staff members including GPs and nurses)	Qualitative design using focus groups Nine focus groups conducted with both community participants and healthcare providers Thematic analysis Research was conducted in five rural localities in the Midland region of New Zealand	Māori lung cancer patients, family, and community members experienced long waiting times, poor communication across health services, and concerns as to how information was shared with them. The need for health services and professionals to better understand the cultural needs of Māori patients and family was highlighted as well as strategies that meet these needs. Family members had to take the initiative at various points in the patient’s cancer care journey, acting as enablers for patients
Otty et al. [35] (2023) Australia Aim: To explore the experiences and perceptions of people with lung cancer and their carers	Lung cancer patients n = 19 Lung cancer carers n = 7 Median age = 64 M/F = 10/9 Northern Australia Regional n = 12 Rural n = 4 Remote n = 3	Cross sectional descriptive qualitative study Qualitative data collected using semi-structured interviews Iterative inductive thematic analysis Rurality defined using MMA	Factors that impacted care experience were good communication, timeliness, patient advocacy, and support. Improper communication, long waiting times, uncertainty about the process, and inconsistent advice negatively impacted care experience
Page et al. [36] (2016) Australia Aim: To survey the level of lung cancer awareness in rural and remote Aboriginal and Torres Straight Islander communities and discover perceived barriers to timely diagnosis and treatment of lung cancer	Lung cancer patients n = 2 Community members n = 51 Health workers n = 14 Queensland, Australia Rural patient n = 1 Urban patient n = 1	Mixed method design Qualitative data collected using interviews Research conducted in outer regional and remote communities in addition to one urban setting	An Indigenous person diagnosed with lung cancer faces unique cultural, physical, and psychological challenges. The only rural patients reported delays in treatment and experienced financial hardship with poor access to culturally targeted information but were satisfied with the support and information provided. Lack of public transport was identified as a barrier to accessing health services in some communities
Rankin et al. [37] (2017) Australia Aim: To describe the lung cancer diagnostic pathway, focusing on the perspective of patients and general practitioners about diagnostic and pre-treatment intervals	Lung cancer patients n = 19 General practitioners n = 11 Mean age = 65 years M/F = 9/10 Sydney and New South Wales Metropolitan (63%) Inner regional (21%) Outer regional (16%)	Qualitative study design using in-depth interviews and a focus group Thematic content analysis using Mile’s and Huberman’s framework Rurality defined using ARIA	The lack of defined diagnostic pathways to respiratory specialist assessment and hospital clinics was frustrating for patients and GPs. Barriers (including travel) to accessing health services caused significant delays after receiving results, creating a sense of urgency. System factors were most salient for regional patients, as the geographical location of specialist providers and diagnostic services significantly impacted making appointments. Four of seven regional patients first presented to the emergency department without previously visiting their GP about symptoms or concerns
Verma et al. [38] (2018) Australia Aim: To identify any differences in time delays in lung cancer referral pathways between rural and urban patients and explore patients’ perceived barriers to timely lung cancer diagnosis	Lung cancer patients n = 252 Mean age = 65.2 M/F = 176/76 North Queensland Urban/Outer regional n = 182 Remote n = 70	Mixed method design Qualitative data collected using semi-structured interviews Thematic analysis Rurality defined using ASGC	Misinterpretation of symptoms was common among rural participants with some citing the reason of “not being a doctor person” for the increased delay in presenting to a GP. Several participants refused investigations causing further delays in diagnosis and management. Some rural participants perceived family commitments and work as more important than their own health. Travel and finance were regarded as barriers in their treatment and management