Table 3 Themes and participant quotes in the help-seeking interval

Barrier

Hesitancy to seek care

“I always had this fear like I was overreacting to things, like ‘I don’t really need to be seen for that. I’m being crazy.’” (Patient #12, 44-year-old female, Stage IV, Never smoking history)

“…You’ve really got two different populations. [There is] the population of patients that pops out and wants to get seen and scanned right away, and then you have the other side of the coin where they’re like ’I don’t want to know,’ [or] ‘I am afraid of what they’re going to tell me,’ so they don’t report their symptoms, or they don’t come in…” (Provider #2, Gynecologic oncology)^a

“We actually are seeing this year that our numbers are down, for peripheral lung cancers, and we think it’s because…people are not going to the [emergency department] (ED) because there are problems here with [COVID-19].” (Provider #7, Cardiothoracic surgery)

Facilitator

Routine care

“I developed a typical cough, which I thought was probably just a normal cough. And I figured it would go away in a couple of weeks and it didn’t. So, in about August, I decided to go to the doctor, my general practitioner.” (Patient #6, 60-year-old male, Stage IV, Never smoking history)

“Patients who are medically literate, and are seeing a doctor on a regular basis, are much more likely to have a chest X-ray, or to report symptoms that might be concerning and prompt a workup.” (Provider #10, Emergency medicine)

“Individuals who are high utilizers of emergency rooms and urgent care but don’t have consistent primary or internal medicine care…[have] another risk factor [because] if you’re seeing a variety of different providers for just acute concerns, it doesn’t necessarily raise the flag of which to delve further into a chronic condition or a malignancy.” (Provider #9, Obstetrics and gynecology)

“There are some patients that [the emergency department] is their only option for healthcare. So, we see [them] more often because they come in for everything. The other patients who get excellent primary care and specialty care outpatient, we only seem to [see them when they] have more of a crisis.” (Provider #6, Emergency medicine)