Article Text
Abstract
Objectives People at high-risk for lung cancer—current/former smokers, aged 40+ years, with serious lung comorbidity (ie, chronic obstructive pulmonary disease) and living in highly deprived areas—are more likely to delay symptom presentation. This qualitative study aimed to understand the influences on early presentation with lung cancer symptoms in high-risk individuals and intervention preferences.
Methods Semi-structured qualitative interviews with 37 high-risk individuals (without a cancer diagnosis), identified through seven GP practices in socioeconomically deprived areas of England, Scotland and Wales (most deprived 20%). A symptom attribution task was used to explore lung symptom perception and help seeking, developed using Leventhal’s Common Sense Model. Four focus groups with 16 high-risk individuals and 12 local stakeholders (healthcare professionals and community partners) were conducted to explore preferences for an intervention to promote early lung cancer symptom presentation. Data were synthesised using Framework analysis.
Results Individual and area level indicators of deprivation confirmed that interview participants were highly deprived. Interviews. Preoccupation with managing ‘treatable’ short-term conditions (chest infections), led to avoidance of acting on ‘inevitable and incurable’ long-term conditions (lung cancer). Feeling judged and unworthy of medical help because of their perceived social standing or lifestyle deterred medical help seeking, particularly when difficult life circumstances and traumatic events led to tobacco and alcohol addiction. Focus groups. Participants recommended multifaceted interventions in community venues, with information about lung cancer symptoms and the benefits of early diagnosis, led by a trained and non-judgemental facilitator.
Conclusions This study was novel in engaging a high-risk population to gain an in-depth understanding of the broader contextual influences on lung cancer symptom presentation. Perceived lack of health service entitlement and complex lives facilitated avoidance of recognising and presenting with lung cancer symptoms. Community-based interventions have the potential to empower disadvantaged populations to seek medical help for lung symptoms.
- primary care
- public health
- qualitative research
- respiratory medicine (see thoracic medicine)
- lung cancer
- socioeconomic status
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Footnotes
Contributors All authors designed the study. GMcC and JH conducted, coded and analysed the interviews and focus group data. All authors contributed to the interpretation of data. GMcC drafted the manuscript and all authors contributed to the review and editing of the manuscript. All authors read and approved the final manuscript.
Funding This work was supported by Cancer Research UK (grant reference number: C16377/A22034).
Competing interests None declared.
Ethics approval The study received ethical approval from Southampton Central- Hampshire A Research Ethics Committee (16/SC/0589).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data are anonymised transcripts. Requests to share data will be considered by the PI on an individual basis in line with a data sharing agreement and subject to compliance with Cardiff University regulations whilst ensuring no loss of confidentiality on the part of the study participants.
Patient consent for publication Not required.
Patient and public involvement Our patient and public contributors (AMT and GN) provided valuable contribution at all stages of the study - from the initial study concept through to interpretation and write up of the results.