title: Lung cancer diagnosed following an emergency admission: exploring patient and carer perspectives on delay in seeking help.
abstract: Compared to others, patients diagnosed with lung cancer following an emergency, unplanned admission to hospital (DFEA) have more advanced disease and poorer prognosis. Little is known about DFEA patients' beliefs about cancer and its symptoms or about their help-seeking behaviours prior to admission.
  
  
  
  As part of a larger single-centre, prospective mixed-methods study conducted in one University hospital, we undertook qualitative interviews with patients DFEA and their carers to obtain their understanding of symptoms and experiences of trying to access healthcare services before admission to hospital. Interviews were recorded and transcribed. Framework analysis was employed.
  
  
  
  Thirteen patients and 10 carers plus 3 bereaved carers took part in interviews. Three patient/carer dyads were interviewed together. Participants spoke about their symptoms and why they did not seek help sooner. They described complex and nuanced experiences. Some (n = 12) had what they recalled as the wrong symptoms for lung cancer and attributed them either to a pre-existing condition or to ageing. In other cases (n = 9), patients or carers realised with hindsight that their symptoms were signs of lung cancer, but at the time had made other attributions to account for them. In some cases (n = 3), a sudden onset of symptoms was reported. Some GPs (n = 6) were also reported to have made incorrect attributions about cause.
  
  
  
  Late diagnosis meant that patients DFEA needed palliative support sooner after diagnosis than patients not DFEA. Professionals and lay people interpret health and illness experiences differently.
authors.affiliation: Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, School of Health Sciences, University of Nottingham, Nottingham, NG7 2UH, UK. glenys.caswell@nottingham.ac.uk.
authors.forename: Glenys
authors.identifier: 0000-0002-8246-8189
authors.initials: G
authors.lastname: Caswell
authors.affiliation: School of Nursing and Midwifery, University of Sheffield, Sheffield, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Seymour
authors.affiliation: Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Vincent
authors.initials: V
authors.lastname: Crosby
authors.affiliation: Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Asmah
authors.initials: A
authors.lastname: Hussain
authors.affiliation: Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Cathann
authors.initials: C
authors.lastname: Manderson
authors.affiliation: Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Farnan
authors.affiliation: Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Freer
authors.affiliation: Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Freemantle
authors.affiliation: Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Fran
authors.initials: F
authors.lastname: Littlewood
authors.affiliation: Division of Cancer and Stem cells, School of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilcock
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D004632:Emergency Medical Services; D005260:Female; D000066505:Help-Seeking Behavior; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: Delay in help seeking; Diagnosed following emergency admission; Late diagnosis; Lay epidemiology; Lung cancer