Electronic versions



  • Grace McCutchan
    Cardiff University
  • Julia Hiscock
  • Kerenza Hood
    South East Wales Trials Unit, Cardiff University
  • Peter Murchie
    University of Aberdeen
  • Richard Neal
    University of Leeds
  • Gareth Newton
    Cardiff University
  • Sara Thomas
    Public Health Wales, Cardiff University
  • Ann Maria Thomas
    Public Health Wales, Cardiff University
  • Kate Brain
    Cardiff University

OBJECTIVES: People at high-risk for lung cancer-current/former smokers, aged 40+ years, with serious lung comorbidity (ie, chronic obstructive pulmonary disease) and living in highly deprived areas-are more likely to delay symptom presentation. This qualitative study aimed to understand the influences on early presentation with lung cancer symptoms in high-risk individuals and intervention preferences.

METHODS: Semi-structured qualitative interviews with 37 high-risk individuals (without a cancer diagnosis), identified through seven GP practices in socioeconomically deprived areas of England, Scotland and Wales (most deprived 20%). A symptom attribution task was used to explore lung symptom perception and help seeking, developed using Leventhal's Common Sense Model. Four focus groups with 16 high-risk individuals and 12 local stakeholders (healthcare professionals and community partners) were conducted to explore preferences for an intervention to promote early lung cancer symptom presentation. Data were synthesised using Framework analysis.

RESULTS: Individual and area level indicators of deprivation confirmed that interview participants were highly deprived. Interviews. Preoccupation with managing 'treatable' short-term conditions (chest infections), led to avoidance of acting on 'inevitable and incurable' long-term conditions (lung cancer). Feeling judged and unworthy of medical help because of their perceived social standing or lifestyle deterred medical help seeking, particularly when difficult life circumstances and traumatic events led to tobacco and alcohol addiction. Focus groups. Participants recommended multifaceted interventions in community venues, with information about lung cancer symptoms and the benefits of early diagnosis, led by a trained and non-judgemental facilitator.

CONCLUSIONS: This study was novel in engaging a high-risk population to gain an in-depth understanding of the broader contextual influences on lung cancer symptom presentation. Perceived lack of health service entitlement and complex lives facilitated avoidance of recognising and presenting with lung cancer symptoms. Community-based interventions have the potential to empower disadvantaged populations to seek medical help for lung symptoms.

Original languageEnglish
Article numbere025902
Pages (from-to)e025902
JournalBMJ Open
Issue number5
Publication statusPublished - 22 May 2019

Total downloads

No data available
View graph of relations