Patient perceptions of barriers to the early diagnosis of lung cancer and advice for health service improvement

Walton, Lisa; McNeill, R; Stevens, Wendy; Murray, Melissa; Lewis, Chris; Aitken, Denise; Garrett, Jeff

doi:10.1093/fampra/cmt001

Cited by 46 publications

(82 citation statements)

References 12 publications

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“…Thus, a more targeted approach of those groups most likely to benefit from an intervention would promise to be both effective and resource-efficient. Recent studies have also indicated the potential effectiveness of targeted, local GP-based interventions, which combine symptom awareness, education, and strategies that reduce complexity in appointment scheduling specifically for patients at-risk of lung cancer[34,45,46]. A randomised controlled trial of one such intervention is currently underway in Australia[47].…”

Section: Discussionmentioning

confidence: 99%

Promoting Help-Seeking in Response to Symptoms amongst Primary Care Patients at High Risk of Lung Cancer: A Mixed Method Study

et al. 2016

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BackgroundLung 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.MethodsMixed 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.ResultsA 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.ConclusionsThis 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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Section: Discussionmentioning

confidence: 99%

Promoting Help-Seeking in Response to Symptoms amongst Primary Care Patients at High Risk of Lung Cancer: A Mixed Method Study

et al. 2016

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“…Research has indicated that patients in the United Kingdom experience symptoms for several months before presenting to health services (Corner, Hopkinson, Fitzsimmons, Barclay, & Muers, ; Corner, Hopkinson, & Roffe, ; Tod, Craven, & Allmark, ). Reasons for delayed presentation include lack of awareness of symptoms, attribution of symptoms to minor health conditions (e.g., a common cold, a smoker's cough) or ageing, and sometimes fear of finding a serious cause and fatalistic beliefs about lung cancer (Brindle, Pope, Corner, Leydon, & Banerjee, ; Corner et al ., , ; Lyratzopoulos, Liu, Abel, Wardle, & Keating, ; McCutchan, Wood, Edwards, Richards, & Brain, ; McLachlan et al ., ; Shim, Brindle, Simon, & George, ; Smith, Pope, & Botha, ; Tod & Joanne, ; Walton et al ., ).…”

Section: Introductionmentioning

confidence: 97%

Developing and testing a web‐based intervention to encourage early help‐seeking in people with symptoms associated with lung cancer

Mueller

Davies

Jay

et al. 2018

British J Health Psychol

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The potential for differential dropout in online randomized trials requires careful consideration. Future help-seeking interventions should provide support for those who have previously felt dismissed by health professionals. The feasibility study provides some evidence that our 'TPB components' were effective, but validation in a powered trial is necessary. Statement of contribution What is already known on this subject? People with lung cancer often delay presenting symptoms to health services. Some patients (or their family/friends) look up symptoms online before their diagnosis, to decide whether they should see a doctor. Interventions are needed to ensure people can find useful information online that will encourage them to seek help for relevant symptoms. What does this study add? Theory-mapping and user involvement facilitated systematic intervention development. Lung cancer help-seeking interventions should address salient beliefs and personal relevance. The potential for differential dropout in online randomized trials requires careful consideration.

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“…Other studies suggest that fragmentation of primary care and shorter consultation times has led to a lack of continuity of care or carer, which may hinder early diagnosis as cancer presentation can be complex in those with comorbidities 16 31 32. In a qualitative study of patients with lung cancer in New Zealand, patients felt that not always seeing the same GP could lead to delays in diagnosis due to poor follow-up 33. In a study in Denmark, the authors suggest that perceived lack of accessibility and doctor–patient relationship were associated with patient delay in seeking advice about cancer symptoms 34.…”

Section: Discussionmentioning

confidence: 99%

Managing risk in cancer presentation, detection and referral: a qualitative study of primary care staff views

2014

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ObjectivesIn the UK, there have been a number of national initiatives to promote earlier detection and prompt referral of patients presenting to primary care with signs and symptoms of cancer. The aim of the study was to explore the experiences of a range of primary care staff in promoting earlier presentation, detection and referral of patients with symptoms suggestive of cancer.SettingSix primary care practices in northwest England. Participants: 39 primary care staff from a variety of disciplines took part in five group and four individual interviews.ResultsThe global theme to emerge from the interviews was ‘managing risk’, which had three underpinning organising themes: ‘complexity’, relating to uncertainty of cancer diagnoses, service fragmentation and plethora of guidelines; ‘continuity’, relating to relationships between practice staff and their patients and between primary and secondary care; ‘conflict’ relating to policy drivers and staff role boundaries. A key concern of staff was that policymakers and those implementing cancer initiatives did not fully understand how risk was managed within primary care.ConclusionsPrimary care staff expressed a range of views and opinions on the benefits of cancer initiatives. National initiatives did not appear to wholly resolve issues in managing risk for all practitioners. Staff were concerned about the number of guidelines and priorities they were expected to implement. These issues need to be considered by policymakers when developing and implementing new initiatives.

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Patient perceptions of barriers to the early diagnosis of lung cancer and advice for health service improvement

Cited by 46 publications

References 12 publications

Promoting Help-Seeking in Response to Symptoms amongst Primary Care Patients at High Risk of Lung Cancer: A Mixed Method Study

Promoting Help-Seeking in Response to Symptoms amongst Primary Care Patients at High Risk of Lung Cancer: A Mixed Method Study

Developing and testing a web‐based intervention to encourage early help‐seeking in people with symptoms associated with lung cancer

Managing risk in cancer presentation, detection and referral: a qualitative study of primary care staff views

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