Patient reported symptoms and triggers to diagnosis for: (A) participants with symptomatic diagnoses who felt well or (B) provided narratives of declining health, and (C) for participants with incidental diagnoses
| Participant | Triggers to diagnosis | Symptoms of concern/disease (elicited by open questions except where indicated) | Symptoms as normal processes (elicited by closed questions except where indicated) |
|---|---|---|---|
| (A) Participants with Symptomatic Diagnoses who felt well | |||
| 06 | Severe cough >3 weeks | Severe productive cough (3–4 times a year of 2 days duration, for 5 years) | Increase in breathlessness and fatigue |
| 08 | Weight loss | Weight loss | *Weight loss—some weight now regained (open question) |
| 12 | Persistent cough; haemoptysis | Persistent, tickly, non-productive, mild cough; haemoptysis | Aches and discomfort: stiff neck and left shoulders; weight loss; some discomfort with coughing as time went on |
| 016 | Cough; fatigue; feeling unwell; appetite loss; weight loss | Appetite loss; weight loss – returned to normal; dry cough; feeling unwell | Increase in breathlessness; a feeling (not pain) ‘that something is going on’ in the chest’; fingers go numb |
| 018 | Chest infection; haemoptysis | Repeated cough; chest infections; regular sneezing and flu like symptoms; sore throat; fatigue; sore testicles; flushing across stomach; ache across back | Increase in breathlessness; pain in centre of chest; occasional coughing with chest infection |
| 023 | Weight loss; anaemia | Flu and a scratchy dry cough; night sweats; weight loss; anaemia; tiredness; sensitive gums; soft hair; taste change (closed question) | Twinges in fingers and hands |
| 024 | Haemoptysis; dysponea | Haemoptysis; night sweats | Cough; breathlessness and wheezing |
| 025 | Dysponea | Pains in legs and joints; fatigue, breathlessness | Chest pain recently when lying down. |
| 027 | Dysponea | Breathlessness on exertion | Occasional hot shooting pain in chest |
| (B) Participants with symptomatic diagnoses who provided decline (D) and Quest for diagnoses (Q) narratives (exceptions to the normalisation of symptoms not presented to GPs/elicited by closed questions) | |||
| 017 (D) | Chest/abdominal pain | Aching pain from indigestion; cough; pain across shoulders; aches; having less energy; breathlessness on resting/panic attacks | |
| Elicited by closed questions: breathlessness on walking and when lying down | |||
| 019 (D) | Anaemia | Sickness if over eat; bleeding in throat and vomiting large amounts of blood (now stopped). | |
| Elicited by closed questions: Pain in stomach; loss of appetite; tiredness; increase in breathlessness; pain in chest when breathing in. | |||
| 020 (D and Q) | Persistent cough | Weight loss; fatigue; taste change; hot and cold sweats; reduction in appetite (closed question) | breathlessness on physical activity; weight loss – some weight now regained (open question) |
| 026 (D and Q) | Persistent cough; recurrent chest infections for the last 10 years | Regular chest infections and productive coughs; recent weight loss; cough triggered by eating, talking and cold air; dullish ache in back; coughing up occasional flecks of blood; fatigue and energy loss; night sweats—started at menopause but now every night (closed question) | |
| (C) Participants with Incidental diagnoses | |||
| Triggers to diagnosis | Symptoms of concern/disease (elicited by open questions) | Symptoms as normal processes (elicited by closed questions) | |
| 03 | CXR following traumatic injury | Gradually increasing breathlessness not noticed until diagnosis. | Weight loss |
| 07 | Routine CXR on hospital admission | Fatigue | |
| 010 | Routine CXR on hospital admission | Change in bowel movements, fatigue | |
| 011 | CXR investigation of increased heart rate following surgery | Breathlessness; aches and pain back of left shoulder under arm and side of chest; fatigue | |
| 021 | CXR investigation of weight loss and anaemia detected by health screen | Anaemia | Weight loss |
| 022 | CXR following traumatic injury | Cough; taste change; bowel changes | |
| 028 | Imaging of kidney to investigate haematuria | Chest infection following investigation for LC | Breathlessness |
*Occasionally, participants would provide a symptom of concern/disease account when describing previous help-seeking, but would then reinterpret and normalise the symptom if it had improved since seeking help.
CXR, chest x-ray; LC, lung cancer.