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Most patients with lung cancer in the UK are diagnosed when curative surgery is no longer an option and late presentation of symptoms to a medical practitioner is recognised as part of the problem. This paper investigates response to symptoms of lung cancer in order to identify areas in which interventions have potential to increase early consultation.
Qualitative interviews were conducted with 42 people with lung cancer who had taken part in a quantitative interview survey. Interviews focused on symptoms and response prior to initial presentation and diagnosis. An integrated model of help-seeking behaviour was developed with reference to sociological and psychological theories to inform data analysis. Respondents who consulted within 12 weeks of symptom on-set were distinguished from those who did not and evidence of difference in their accounts sought.
Sociological and psychological models of response to symptoms are remarkably similar. “Domains” of response included the nature of symptoms, explanations for them, descriptions of action taken over time and prompting to respond from a family member. Respondents reported drawing on existing knowledge of symptoms, their likely cause and perceptions of personal risk. The nature of symptoms (acute, severe, chronic) was reported as influential as were family members who noticed symptoms. Causal theorising was ubiquitous and included explanations for symptoms in relation to cause and label; likely consequences; perceptions of control; consequences and how long it was likely to last. Actions included self-medication and “wait and see” strategies which were reassessed over time. People who consulted within 12 weeks of onset described symptoms that were largely acute and noticed by others but otherwise no differences were apparent. Smokers in particular reported unrealistic optimism of personal risk of lung cancer.
Models of illness behaviour from different social science disciplines can be integrated and used to frame understanding of reports of response to symptoms of lung cancer. Knowledge of symptoms is not wide-spread and symptoms attributable to benign causes unless acute or severe. Family members and other play an important role in prompting response. Interventions can target knowledge and the role of others in the context of theories of behaviour change.