Table 3.

Analytical themes, descriptive themes, initial codes, and examples quotes from the qualitative analysis

Analytical theme and definition	Descriptive themes	Initial codes	Example quotes
Diagnosis and treatment pathways This theme relates to participants experiences of diagnosis and their treatment. For some, their diagnosis was unexpected. Participants reported frustrations with delays and long waiting times	Unexpected diagnosis	Shock of being diagnosed Sudden and unexpected diagnosis Surprise/potential misdiagnosis	“Yeah well I was shocked because um, you expect people who smoked and went out drinking and things like that, you know. Um, and you think if you look after yourself and be healthy and not being obese, ah, rather surprised me. I mean, if I was obese or something like that I would expect it I suppose” [32] “I mean my tumor was 6 cm when it was eventually diagnosed at the (metropolitan hospital) a week later. It could not grow just in a minute, it had to have been there for at least a long time…” [35]
	Treatment delays	Perceived unnecessary delays to treatment Long delays before initiating treatment Frustration in treatment delay	“With bronchoscopy – mucked around a bit, should have got on with treatment” [33] “And it was just near the end that I felt like, oh my god, please can we get something going, because I was really well aware of the fact there was really something there then, and I just wanted something to start” [35]
	Poor follow-up support	Abandonment after treatment Insufficient follow-up and support Felt let down after treatment	“Felt abandoned at end of treatment – back to GP” [33] “Then I got handed over to a number of other doctors. And so come November when it all finished, there was no indication of appointment follow-ups or scan or anything. And that’s where they fell down there a little bit” [35]
	Long waiting times	Unnecessary discharge wait Used to experiencing long waiting times Frustration in waiting for information	“Easy to get into each place and have treatment or tests, but getting clearance to leave often long overdue and waiting needlessly” [33] “You get used to the waiting, and although XXX Hospital very good it was a long day with the transport” [33]
	Undiagnosed and misdiagnosis	Misdiagnosis of lung cancer Undiagnosed lung cancer	“It was just the coughing up blood. Because I’ve got COPD anyway, I do have a little bit of breathlessness all the time, the doctor told me it was pneumonia.” [35] “I mean my tumor was 6 cm when it was eventually diagnosed at the (metropolitan hospital) a week later. It could not grow just in a minute, it had to have been there for at least a long time…” [35]
	Patient advocates	Family members acting as patient advocate Healthcare staff acting as patient advocate	“My brother, he actually took me on. Because I was too ill to email and fight for my rights so he took my email and started to say look when am I gonna get treatment? And he just happened to be rung to say we’re having this [PET] scan… And I was in there and he rung the oncologist and said my sister is in there now having a PET scan, please if you have a spare bed can she go in. And I went straight from there up, through my 1st round of chemo. But you have to fight as well for your treatment. And when you’re too ill, get someone who can talk to the pathologist or radiologist, to say when is it going to happen.” [34]
Travel and financial burden This theme relates to the travel and financial burden as a consequence of their lung cancer diagnosis. Hospitals in metropolitan urban centers were considered inaccessible and time consuming to get to. Having lung cancer also placed significant financial strain on the participants	Travel burden	Poor understanding of travel distance Long travel distances Adverse to travelling long distances for treatment Travel a barrier to accessing treatment	“I had to drive up to Perth to see the doctor and then 2 days later go up again for the start of treatment. They didn’t seem to understand the time and money” [31] “If I had to go to Brisbane for lung treatment, I would not go. Neither would others, especially Indigenous. Getting down to Brisbane is very hard” [36] After the biopsy was done I was back in (regional city) again to see (the respiratory physician). He got in touch with Professor (of radiation oncology) because he wanted us to go to Sydney (for treatment) and I said “well can’t we go to Orange?” It was so much easier for us.” [37]
	Financial burden	Poor understating of financial impact Financial worry Petrol and accommodation costs	“Now there is a problem with me getting to Townsville. My friend drove me last time and I still have not got any petrol money or accommodation money.”[38] “Great strain on finances” [33]
Communication and information This theme related to communication between health professionals and patients in relation to their lung cancer diagnosis and treatment. There were reports of poor communication, too much information, and a lack of information and examples of good communication from health professionals	Poor communication	Improved patient communication needed Difficulty in obtaining information Greater time needed for questions and understanding Impersonal communication approach	“Have to drag every bit of information out of the doctors – irritating them” [33] “Didn’t know initially which form of cancer it was and waiting to hear was very worrying” [33] “But in very broken English over a very bad phone line, I heard that – (1) I had lung cancer, (2) it had spread to my bones, hips, spine, lymph system; with treatment would be 12 months and I would be dead. Basically, the phone call was over in 15 min. Suddenly it went from I’m getting no information; I’m getting information that is unexpected, uncontextualized and not given in a format where I have the opportunity to understand or ask questions.” [35]
	Poor information and awareness	Poor self-management information Inadequate diagnosis and treatment information Unaware of supportive information	“When we were going through my chemo and radiotherapy … I lost a lot of weight, and we were looking for healthy ways to put on weight, and the recommendation at the hospital from the doctor was just go to McDonalds and have a chocolate thick shake. There’s no focus on quality nutrition.” [30] “did get information on the pill, which I still have. Um and I kind of understand what it’s doing.” [30]
	Too much information	Irrelevant and unnecessary information Overwhelmed with information	“I suppose because I do not know anything medical, do not want to see pictures, I just want to get on with it. I just want to get told what I have to do to get this over and done with’.” [35] “I think we received quite enough information. Like I think the only thing I wanted to know is, how much time have I got?” [35]
	Good communications	Good explanations and communication with patient Allowed time for patient to ask questions Adapting communicative skills	“The radiation oncologist lady was excellent. She talked you through things, she explained things, she gave you, gave you space to have an opinion or to ask questions” [30] “Happy with explanations given at radiation clinic, can understand it all: Scale of 1–10 = 10!” [33] “He was upfront, he said it me that it was that they had found a mass. He said a picture paints a thousand words, so he showed me my x-rays, and showed me how one third of my left lung had collapsed and showed me the mass that was on my lung.” [35]
Experiences of interacting with healthcare professionals This relates to people with lung cancer being dissatisfied with the healthcare professionals delivering their care. There were reports of a lack of sympathy and compassion. Finally, there were several participants who reported positive experiences of their interactions with healthcare professionals	Dissatisfied with healthcare settings and professionals	Poor attitude towards patient care Transparency in communicative behavior Impersonal nature of healthcare professionals Poor facilities and diagnostic/treatment centers	“but the medical oncologist at the [hospital] was disgusting.” [30] “Grave with care at AAA, nursing atrocious, attitude shocking and husband ignored; [need] better standard of nursing care” [33] “Worried when came back from Perth and in hospital again and hair falling out as no one had sent any paperwork to XXX for the next chemo treatment – specialist said not expected to live long enough to need it anyway!” [33]
	Indifferent attitude	Lack of empathy and compassion Arrogant and impersonable Insensitive nature	“When told diagnosis – lady could have been a bit more sympathetic” [33] “First time I had to deal with specialists, so have nothing to compare with but couldn’t stand the arrogance of those I saw” [33]
	Satisfied with healthcare professionals	Knowledgeable healthcare professionals Healthcare professionals attentive to care needs Provided adequate information Time taken to explain information Confidence in healthcare professional	“Excellent; feel doing everything possible and no stone unturned, confident because of it” [33] “Lots of time and trouble taken to explain things and I appreciated the booklet from the hospital” [33]
Symptoms and health-seeking behaviors The final theme relates to some rural people with lung cancer having traits of stoicism and being reluctant to ask for help especially due to their distance from acute treatment centers	Reluctance to seek help	Stoicism and sociocultural influences in seeking medical help Distance a barrier to seeking medical help	“And the country men are worse than the women, by a long shot. They’re, you know, bush blokes. You know, “I’m not going to the doctor. I’ll be right, mate” [32] And I’m thinking that, no this... this could get better without a trip into town. Because we... because we’re 40 k’s out, you think twice about coming in for every little cough and sniffle” [32]
	Comorbidities	Symptoms masked by co-existing conditions	“It was just the coughing up blood. Because I’ve got COPD anyway, I do have a little bit of breathlessness all the time” [35]
	Caring responsibilities	Prioritizing caring responsibilities over own health	“I am working hard looking after my handicapped son, that I did not pay attention to my cough, and that it had been worsening.” [38]