Promoting help-seeking in response to symptoms amongst primary care patients at high risk of lung cancer: a mixed method study

Wagland, Richard; Brindle, Lucy; Ewings, Sean; James, Elizabeth; Moore, Mike; Rivas, Carol; Esqueda, Ana Ibanez; Corner, Jessica

Abstract

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.

Citation

Wagland, R., Brindle, L., Ewings, S., James, E., Moore, M., Rivas, C., …Corner, J. (2016). Promoting help-seeking in response to symptoms amongst primary care patients at high risk of lung cancer: a mixed method study. PLoS ONE, 11(11), 1-20. https://doi.org/10.1371/journal.pone.0165677

• Journal Article Type: Article
• Acceptance Date: Oct 14, 2016
• Online Publication Date: Nov 4, 2016
• Publication Date: Nov 4, 2016
• Deposit Date: Feb 9, 2017
• Publicly Available Date: Feb 9, 2017
• Journal: PLoS ONE
• Electronic ISSN: 1932-6203
• Publisher: Public Library of Science
• Peer Reviewed: Peer Reviewed
• Volume: 11
• Issue: 11
• Article Number: e0165677
• Pages: 1-20
• DOI: https://doi.org/10.1371/journal.pone.0165677
• Public URL: https://nottingham-repository.worktribe.com/output/830058
• Publisher URL: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0165677
• Contract Date: Feb 9, 2017