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Wagland, Richard; Brindle, Lucy; Ewings, Sean; James, Elizabeth; Moore, Mike; Rivas, Carol; Esqueda, Ana Ibanez; Corner, Jessica (2016)
Publisher: Public Library of Science
Journal: PLoS ONE
Languages: English
Types: Article
Subjects: Research Article, Diagnostic Medicine, Research Design, Signs and Symptoms, Pathology and Laboratory Medicine, Respiration, Oncology, Coughing, Lung and Intrathoracic Tumors, Cancer Detection and Diagnosis, Cancers and Neoplasms, Survey Research, Health Care, Biology and Life Sciences, Breathing, Research and Analysis Methods, Physiology, Medicine, Pulmonology, Health Education and Awareness, Questionnaires, Q, R, Science, Primary Care, Medicine and Health Sciences, Physiological Processes, Chronic Obstructive Pulmonary Disease
Background: Lung cancer symptoms are vague and difficult to detect. Interventions are needed to promote early diagnosis, however health services are already pressurised. This study explored symptomology and help-seeking behaviours of primary care patients at ‘high-risk’ of lung cancer (?50 years old, recent smoking history), to inform targeted interventions.

Methods: Mixed method study with patients at eight general practitioner (GP) practices across south England. Study incorporated: postal symptom questionnaire; clinical records review of participant consultation behaviour 12 months pre- and post-questionnaire; qualitative participant interviews (n = 38) with a purposive sample.

Results: A small, clinically relevant group (n = 61/908, 6.7%) of primary care patients was identified who, despite reporting potential symptoms of lung cancer in questionnaires, had not consulted a GP ?12 months. Of nine symptoms associated with lung cancer, 53.4% (629/1172) of total respondents reported ?1, and 35% (411/1172) reported ?2. Most participants (77.3%, n = 686/908) had comorbid conditions; 47.8%, (n = 414/908) associated with chest and respiratory symptoms. Participant consulting behaviour significantly increased in the 3-month period following questionnaire completion compared with the previous 3-month period (p = .002), indicating questionnaires impacted upon consulting behaviour. Symptomatic non-consulters were predominantly younger, employed, with higher multiple deprivation scores than their GP practice mean. Of symptomatic non-consulters, 30% (18/61) consulted ?1 month post-questionnaire, with comorbidities subsequently diagnosed for five participants. Interviews (n = 39) indicated three overarching differences between the views of consulting and non-consulting participants: concern over wasting their own as well as GP time; high tolerance threshold for symptoms; a greater tendency to self-manage symptoms.

Conclusions: This first study to examine symptoms and consulting behaviour amongst a primary care population at ‘high- risk’ of lung cancer, found symptomatic patients who rarely consult GPs, might respond to a targeted symptom elicitation intervention. Such GP-based interventions may promote early diagnosis of lung cancer or other comorbidities, without burdening already pressurised services.

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