Focus group methodology has been applied extensively in healthcare and medical research, particularly to assess the illness experience and patient understanding [19
]. In lung cancer care, investigators have explored beliefs about surgical resection for early-stage disease and preferences for chemotherapy for advanced-stage disease [20
]. To capture subjects who were both familiar with treatment considerations and potentially eligible for maintenance therapy, we limited participation to patients who had already initiated but not yet completed first-line chemotherapy.
We conducted two focus groups at the university cancer center oncology clinic and a third focus group in the oncology clinic at our county hospital partner. Participants had advanced NSCLC and were currently receiving platinum doublet chemotherapy. Patients were identified through treating physicians and recruited by trained research and clinical staff. We excluded patients who did not speak English, or had a speech or treatment-derived cognitive impairment that rendered them incapable of informed consent to participate in a focus group. We recognize this as a potential study limitation. However, although Dallas County is 39% Hispanic, only about 5% of lung cancer patients seen by our facilities are Hispanic.[22
] As a result, language exclusion did not have a significant impact on sample selection. Potential subjects were approached either by telephone or in person to participate in a patient group discussion (est. 90 minutes). Interested patients gave verbal assent and were scheduled for a focus group. Participants were compensated with a gift card ($20) for their time and effort. The study was approved by the UT Southwestern Institutional Review Board.
Clinical data gathered from the electronic medical record included patient age, sex, race, treatment plan, number of treatment cycles at time of consent, treatment response, clinical trial participation, and future treatment plans. Based on eligibility criteria, we identified an initial eligible study population of 47 patients. Of these, ultimately 13 (27%) participated in a focus group (4, 4, 5 participants, respectively), of whom seven (54%) were men and ten (77%) were white (). All participants were currently undergoing first-line treatment; only those who felt well enough chose to attend scheduled sessions.
Participant Socio-demographics and Clinical Status
To explore implications of a maintenance therapy paradigm, the investigator team generated a discussion guide covering a range of issues related to the patient treatment experience (). Focus groups were moderated by a qualitative investigator with a second behavioral investigator present to monitor group dynamics and assist with facilitation. Immediately prior to each focus group, investigators explained the purpose of the study, solicited written informed consent, and explained the use of audio recording for the purpose of transcription. Using a two-slide presentation, a physician investigator then presented a brief overview of the traditional model of first- and second-line treatment for advanced NSCLC and introduced the concept of maintenance therapy (). The physician investigator turned the session over to the moderator and left the room. The moderator used the discussion guide to invite conversation about the possibility of maintenance therapy, first posing a question to the group then eliciting comments from participants in turn, allowing unstructured time for participants to compare and contrast their experiences and opinions with each other. As the moderator exhausted the discussion guide, the physician investigator returned to address participant questions. Each focus group was audio-recorded and subsequently transcribed verbatim.
Focus Group Questions and Probes
Schematic of “traditional” and “maintenance” chemotherapy for advanced NSCLC displayed at throughout each focus group session.
Following each focus group, the investigator team discussed participant reactions and other emerging issues. Investigators compared and contrasted participant attitudes and noted emerging conceptual domains. The team reviewed transcripts and assessed patient issues using an inductive, text-driven approach to thematic content analysis [23
]. Investigators collectively identified preliminary themes, leading to theme consolidation and extraction, with subsequent iterative discussion and analysis by the whole team [25