Flats on tour: Well, I'm going to curse myself here and potentially end my lucky streak, but I've not had a flat on tour during the last 7 years. Now, I have not done an epic tour during that time, mostly 14 day-long or so tours, 7 or 8 of them during that 7 year period time. Across my riding more broadly, maybe a flat ever 1200-1500 miles or so on pavement. I haven't ridden in thorn country, and I'm pretty on top of replacing tires proactively.
Tubes: I carry 2 tubes for self-contained touring, one tube for all other riding (plus patch kit). Bad experience glueless patches. Great results w/ the Rema patch kits, but do make sure your cement is not dried out!! I will check out the Tear Aid product mentioned above, never heard of it but always open to potentially good stuff.
Spare tires: Never carried one. It's been a couple of decades since I've torn a sidewall on a road tour, and I think I fixed that w/ the old dollar bill tire boot. Again, I've not done an epic long tour in ages. If I'm gonna be in nowhere land for a very long time, I might well bring along a folding tire.
Patch or replace: Both. Generally, replace on side of road, patch at home (day ride, bike overnight)/campsite (tour).
Extra Tire Protection: I carry a Park tire boot in toolkit for all of my bikes. That's it, no liners and no sealant in the tubes.