Engaging high-risk groups in early lung cancer diagnosis: a qualitative study of symptom presentation and intervention preferences amongst the UK’s most deprived communities

Objectives People at high-risk for lung cancer - current/former smokers, aged 40+ years, with serious lung comorbidity (i.e. 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 18 high-risk individuals and 16 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’ longer-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 multi-faceted interventions in community venues, with information about lung cancer symptoms and the benefits of early diagnosis, led by a trained and non-judgemental facilitator