title: An Interpretative Phenomenological Analysis of the lived experience of multiple concurrent symptoms in patients with lung cancer: a contribution to the study of symptom clusters.
abstract: OBJECTIVE
  To explore the lived experience of multiple concurrent symptoms in people with advanced lung cancer to contribute to the understanding of the experience of symptom clusters.
  
  
  METHODS
  Purposive sampling recruited ten people with advanced lung cancer who were experiencing three or more concurrent symptoms, were at least 18 years of age and were able to provide written informed consent. The participants took part in two consecutive, in-depth interviews, 3-5 weeks apart. Interpretative Phenomenological Analysis was used to analyse the data.
  
  
  RESULTS
  Participants experienced 4-11 concurrent symptoms with fatigue, cough, pain and breathlessness featuring prominently in their interviews. The participants commonly identified associations between the symptoms that they experienced, with the occurrence of one symptom often used to explain the occurrence of another. Reductions in physical and social functioning were often associated with the experience of multiple concurrent symptoms, particularly at times of high symptom severity. The participants' highlighted breathlessness and cough as being of particular salience, due to the association of these symptoms with fear of death and visibility and embarrassment in public.
  
  
  CONCLUSIONS
  People with lung cancer experience multiple concurrent symptoms and perceive relationships between the symptoms experienced. Within the experience of multiple symptoms, people with lung cancer highlight individual symptoms that are of particular importance, based on their concomitant meanings. Such findings provide vital information for the future development of meaning-based symptom cluster interventions.
authors.affiliation: School of Health and Social Care, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7TE, UK. Electronic address: r.maguire@surrey.ac.uk.
authors.forename: Roma
authors.initials: R
authors.lastname: Maguire
authors.affiliation: School of Nursing, Midwifery and Health, University of Stirling, Stirling FK9 4LA, UK. Electronic address: k.m.stoddart@stir.ac.uk.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Stoddart
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 OBA, Scotland, UK. Electronic address: p.flowers@gcu.ac.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Flowers
authors.affiliation: Hairmyres Hospital, NHS Lanarkshire, Eaglesham Road, East Kilbride, G75 8RG, UK. Electronic address: John.mcphelim@lanarkshire.scot.nhs.uk.
authors.forename: John
authors.initials: J
authors.lastname: McPhelim
authors.affiliation: School of Health and Social Care, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7TE, UK. Electronic address: n.kearney@surrey.ac.uk.
authors.forename: Nora
authors.initials: N
authors.lastname: Kearney
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D036301:Qualitative Research; D063189:Symptom Assessment
keywords: Interpretative Phenomenological Analysis; Lung cancer; Meaning; Multiple symptoms; Patient experience; Qualitative research; Symptom clusters