Family physicians’ competencies for early lung cancer detection in an atypical epidemiological context in Cuba: a mixed-methods study

Abstract

Early detection of lung cancer is essential to reduce mortality. This study assessed the competencies (knowledge, clinical practices, and attitudes) of family physicians for such detection in Guantánamo, Cuba, a region with an atypical epidemiological profile (93% of cases in non-smokers; 67.5% linked to occupational exposure). A mixed-methods study with methodological triangulation. An adapted validated questionnaire (pilot subscales α = 0.82–0.91; overall α = 0.91) was administered to 279 family physicians, 532 clinical records were reviewed, two focus groups with 14 physicians and eleven semi-structured interviews with administrators were conducted, and an observation guide was applied. Data were analysed using descriptive statistics and thematic analysis. A total of 92.7% of participants showed favourable attitudes toward early detection. However, only 47.3% knew the clinical guidelines and 34.7% correctly identified occupational risk factors. A total of 92% of clinical records were outdated and systematic follow-up was evident in only 3.8% of cases. Triangulation revealed substantial agreement across data sources (kappa > 0.75). There is a marked dissociation between favourable attitudes and adequate clinical practice. These findings support the implementation of cancer education strategies in primary health care.