Abstract
Purpose
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.
Methods
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.
Results
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.
Conclusion
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.
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References
Walters S, Maringe C, Coleman MP (2013) Lung cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK: a population-based study, 2004-2007. Thorax 68:551–564. doi:10.1136/thoraxjnl-2012-202297
Elliss-Brookes L, McPhail S, Ives A, Greenslade M, Shelton J, Hiom S, Richards M (2012) Routes to diagnosis for cancer—determining the patient journey using multiple routine data sets. Br J Cancer 107:1220–1226. doi:10.1038/bjc.2012.408
Department of Health (2012) Improving outcomes: a strategy for cancer. Crown Copyright, London http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123371 (Accessed October 15, 2014)
Beckett P, Tata LJ, Hubbard RB (2014) Risk factors and survival outcome for non-elective in non-small cell lung cancer patients—analysis based on the National Lung Cancer Audit. Lung Cancer 83:396–400. doi:10.1016/j.lungcan.2013.10.010
Andersen BL, Cacioppo JT, Roberts DC (1995) Delay in seeking a cancer diagnosis: delay stages and psychophysiological comparison processes. Br J Soc Psychol 34:33–52
Corner J, Hopkinson J, Fitzsimmons D, Barclay S, Muers M (2005) Is late diagnosis of lung cancer inevitable? Interview study of patients’ recollections of symptoms before diagnosis. Thorax 60:314–319. doi:10.1136/thx.2004.029264
Brindle L, Pope C, Corner J, Leydon G, Banerjee A (2012) Eliciting symptoms interpreted as normal by patients with early-stage lung cancer: could GP elicitation of normalised symptoms reduce delay in diagnosis? Cross-sectional interview study. BMJ Open 2. doi:10.1136/bmjopen-2012-01977
Corner J, Hopkinson J, Roffe L (2006) Experience of health changes and reasons for delay in seeking care: a UK study of the months prior to diagnosis of lung cancer. Soc Sci & Med 62:1381–1391. doi:10.1016/j.socscimed.2005.08.012
Tod AM, Craven J, Allmark P (2008) Diagnostic delay in lung cancer: a qualitative study. JAN 61:336–343. doi:10.1111/j.1365-2648.2007.04542.x
Forbat L, Place M, Hubbard G, Leung H, Kelly D (2014) The role of interpersonal relationships in men’s attendance in primary care: qualitative findings in a cohort of men with prostate cancer. Support Care Cancer 22:409–415
Nettleton S (2013) The sociology of health and illness, 3rd edn. Polity Press, Cambridge
Campbell SM, Roland MO (1996) Why do people consult the doctor? Fam Pract 13:75–83
Noone JH, Stephens C (2008) Men, masculine identities, and health care utilisation. Sociology of Health & Illness 30:711–725
Vogel DL, Wade NG, Wester S, Larson L, Hackler AH (2007) Seeking help from a mental health professional: the influence of one’s social network. J Clin Psychol 63:233–245
Gift AG, Stommel M, Jablonski A, Given W (2003) A cluster of symptoms over time in patients with lung cancer. Nurs Res 52:393–400
Maguire R, Stoddart K, Flowers P, McPhelim J, Kearney N (2014) 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. Eur J of Oncology Nursing 18:310–315. doi:10.1016/j.eon.2014.02.004
Walter FM, Rubin G, Bankhead C, Morris HC, Hall K, Dobson C, Rintoul RC, Hamilton W, Emery J (2015) Symptoms and other factors associated with time to diagnosis and stage of lung cancer: a prospective cohort study. Br J Cancer:112. doi:10.1038/bjc.2015.30
Krishnasamy M, Wells M, Wilkie E (2007) Patients and carer experiences of care provision after a diagnosis of lung cancer in Scotland. Support Care Cancer 15:327–332. doi:10.1007/s00520-006-0129-3
McLachlan S, Mansell G, Sanders T, Yardley S, van der Windt D, Brindle L, Chew-Graham C, Little P (2015) Symptom perceptions and help-seeking behaviour prior to lung and colorectal cancer diagnoses: a qualitative study. Fam Pract 32:568–577. doi:10.1093/fampra/cmv048
Walton L, McNeill R, Stevens W, Murray M, Lewis C, Aitken D, Garrett J (2013) Patient perceptions of barriers to the early diagnosis of lung cancer and advice for health service improvement. Fam Pract 30:436–444. doi:10.1093/fampra/cmt001
Athey VL, Suckling RJ, Tod AM, Walters SJ, Rogers TK (2012) Early diagnosis of lung cancer: evaluation of a community-based social marketing intervention. Thorax 67:412–417. doi:10.1136/thoraxjnl-2011-200714
Department of Health (2011) New lung cancer awareness campaign launched in the East Midlands. Accessed 06/05/2014 http://www.cancerresearchuk.org/cancer-info/prod_consump/groups/cr_common/@nre/@hea/documents/generalcontent/cr_078046.pdf
Mayden (2012) Lung cancer awareness campaign evaluation. National Cancer Action Team. http://www.eastmidlandscancernetwork.nhs.uk/Library/1204NCAT_Lung_cancer_awareness_campaign_report_V2final.pdf
Public Health England (2013) Be clear on cancer. Accessed 06/05/2014 (http://www.nhs.uk/be-clear-on-cancer/lung-cancer/home
Wilcock A, Crosby V, Freer S, Freemantle A, Caswell G, Seymour J (2013) Lung cancer diagnosed following emergency admission: a mixed methods study protocol to improve understanding of patients’ characteristics, needs experiences and outcomes. BMC Pall Care 12. http://www.biomedcentral.com/content/pdf/1472-684X-12-24.pdf
Wilcock A, Crosby V, Hussain A, McKeever TM, Manderson C, Farnan S, Freer S, Freemantle A, Littlewood F, Caswell G, Seymour J (2016) Lung cancer diagnosed following an emergency admission: mixed methods study of the management, outcomes and needs and experiences of patients and carers. Respir Med 114:38–45. doi:10.1016/j.rmed.2016.03.006
Tong A, Sainsbury P, Craig J (2007) Consolidated criteria for reporting qualitative research (COREQ): a 32 item checklist for interviews and focus groups. Int J Qual Health Care 19(6):349–357
Charmaz K (2006) Constructing grounded theory, a practical guide through qualitative analysis. Sage, London
Hoogerwerf MA, Ninaber MK, Willems LNA, Kaptein AA (2012) “Feelings are facts”: illness perceptions in patients with lung cancer. Resp Med 106:1170–1176. doi:10.1016/j.rmed.2012.04.006
Calnan M (1987) Health and illness the lay perspective. Tavistock, London
Davison C, Smith GD, Frankel S (1991) Lay epidemiology and the prevention paradox: the implications of coronary candidacy for health education. Sociology of Health & Illness 13:1–19
Macdonald S, Watt G, Macleod U (2013) In search of the cancer candidate: can lay epidemiology help? Sociology of Health & Illness 35:575–591. doi:10.1111/j.1467-9566.2012.01513.x
Dein S (2004) Explanatory models of and attitudes towards cancer in different cultures. Lancet 5:119–124
Acknowledgements
This research was funded by the Roy Castle Lung Cancer Foundation, grant reference: 2012/20/Wilcock.
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The study was approved by the National Research Ethics Service Committee East Midlands—Nottingham 1 (12/EM/0305) and adopted onto the UK National Institute of Health Research portfolio (12993).
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Caswell, G., Seymour, J., Crosby, V. et al. Lung cancer diagnosed following an emergency admission: exploring patient and carer perspectives on delay in seeking help. Support Care Cancer 25, 2259–2266 (2017). https://doi.org/10.1007/s00520-017-3633-8
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DOI: https://doi.org/10.1007/s00520-017-3633-8