title: Responding to symptoms suggestive of lung cancer: a qualitative interview study.
abstract: BACKGROUND
  Late diagnosis of lung cancer can impact on survival rates. Patients delay seeking help for a number of reasons. This study explored symptom appraisal and help-seeking decisions among patients referred to specialist respiratory services with symptoms suggestive of lung cancer.
  
  
  METHODS
  In-depth qualitative interviews with patients as soon as possible after referral, ideally before diagnosis and mainly within 10 weeks, explored factors impacting on their pathways prior to referral. Framework analysis, underpinned by the Model of Pathways to Treatment, was used to explore the data with particular focus on patients' beliefs and experiences, disease factors and healthcare professional influences.
  
  
  RESULTS
  35 patients were interviewed (aged 41-88 years, 15 women, 17 with lung cancer). All described similar presenting symptoms and triggers to seek help. Appraisal of symptoms was influenced by whether they had a lung comorbidity; seriousness of symptoms was interpreted within the context of previous illness experiences. Help-seeking was triggered when: symptoms failed to respond as expected; there was an increased awareness of symptoms of lung cancer; the public nature of a cough meant others were able to endorse help-seeking. Almost half visited the general practitioner (GP) two or more times before referral; during this period they reinterpreted initial symptoms and appraised new symptoms. The meaning given to symptoms changed over time and many became increasingly concerned they may have lung cancer. The GP played a role in ensuring timely further help-seeking but often there was little guidance on how to monitor symptoms or when to reconsult.
  
  
  CONCLUSIONS
  Patients diagnosed with and without lung cancer had similar symptom pathways. Findings provide guidance for lung cancer awareness campaigns on the importance of social networks in endorsing patient help-seeking. The importance of appropriate advice, monitoring and safety-netting procedures by GPs for people presenting with symptoms suggestive of lung cancer is also highlighted.
authors.affiliation: Department of Public Health & Primary Care , University of Cambridge , Cambridge , UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Birt
authors.affiliation: School of Medicine, Pharmacy & Health, Durham University , Durham , UK.
authors.forename: Nicky
authors.initials: N
authors.lastname: Hall
authors.affiliation: General Practice & Primary Care Academic Centre, University of Melbourne , Melbourne , Australia.
authors.forename: Jon
authors.initials: J
authors.lastname: Emery
authors.affiliation: School of Social & Community Medicine, University of Bristol , Bristol , UK.
authors.forename: Jon
authors.initials: J
authors.lastname: Banks
authors.affiliation: Department of Public Health & Primary Care , University of Cambridge , Cambridge , UK.
authors.forename: Katie
authors.initials: K
authors.lastname: Mills
authors.affiliation: Lay Member of Study Steering Committee.
authors.forename: Margaret
authors.initials: M
authors.lastname: Johnson
authors.affiliation: University of Exeter , Exeter , UK.
authors.forename: Willie
authors.initials: W
authors.lastname: Hamilton
authors.affiliation: Department of Public Health & Primary Care , University of Cambridge , Cambridge , UK ; General Practice & Primary Care Academic Centre, University of Melbourne , Melbourne , Australia.
authors.forename: Fiona M
authors.identifier: 0000-0002-7191-6476
authors.initials: FM
authors.lastname: Walter
keywords: Lung Cancer; Psychology