What are the similarities and differences in lung cancer symptom appraisal and help‐seeking according to smoking status? A qualitative study with lung cancer patients

• Published in: Psycho-oncology (Chichester, England) Vol. 31; no. 12; pp. 2094 - 2103
• Main Authors: Black, Georgia B., Os, Sandra, Whitaker, Katriina L., Hawkins, Gill S., Quaife, Samantha L.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.12.2022; John Wiley and Sons Inc
• Subjects: Appraisal; Common sense; Comorbidity; Coping; diagnostic uncertainty; Health behavior; Health psychology; Health status; Help seeking behavior; help‐seeking; Humans; Lung cancer; Lung Neoplasms - diagnosis; Medical diagnosis; Original; patient safety; Patient satisfaction; Primary care; Qualitative Research; risk appraisal; Smoking; Smoking - epidemiology; smoking history; Symptoms; Urgency; Vigilance; help-seeking; lung cancer; diagnostic uncertainty; smoking history; patient safety; risk appraisal
• ISSN: 1057-9249; 1099-1611
• DOI: 10.1002/pon.6041

Objective Lung cancer in never‐smokers represents a growing proportion of patients. The relationship between smoking status, symptom appraisal and help‐seeking behaviour is complex. Little is known about cancer symptom‐related health behaviours according to smoking status. The aim of the study was to explore lung cancer patients' experiences of a lung cancer diagnosis, identifying differences by smoking history. Method This was a qualitative study involving telephone interviews with 40 lung cancer patients (20 never smokers, 11 former smokers and 9 current smokers). We used framework analysis to analyse the data using the Common Sense Model of Illness Self‐Regulation as a theoretical framework, developed after initial analysis. Results All patients were likely to delay seeking help for symptoms in primary care regardless of smoking history, but for different reasons. Smoking history was instrumental to how individuals perceived and responded to early symptoms of lung cancer. Differences in interpretation and coping responses to new symptoms seemed to be caused by the higher presence of comorbidities due to smoking, and perceptions of the current state of health. Individuals with a smoking history reported acting with urgency in seeking help and follow up, whereas patients who experienced low levels of concern were more easily reassured by clinicians, resulting in delays. Conclusions Never and former smokers perceive, interpret, and respond to symptoms of lung cancer differently to smokers. However, few people attribute their lung symptoms to cancer initially, even with a smoking history. Interventions that drive increased urgency and vigilance in never smokers may be effective.