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

Grace M. McCutchan (Corresponding Author), Julia Hiscock, Kerenza Hood, Peter Murchie, Richard D. Neal, Gareth Newton, Sara Thomas, Ann-Maria Thomas, Kate Brain

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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.


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.


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.


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
JournalBMJ Open
Issue number5
Early online date22 May 2019
Publication statusPublished - 2019

Bibliographical note


This work was supported by Cancer Research UK (grant reference number: C16377/A22034).


We would like to thank everyone who helped with recruitment for this study, and all the participants who took part in the study; without these individuals this study would not have been possible. We would like to thank the Advisory Group (Anthony Byrne, Gareth Collier, Adrian Edwards, Dyfed Huws, David Lewis, Maura Matthews and Fiona Walter) and the study Administrator Lucy Watkins, for their ongoing support and advice throughout the study.


  • lung cancer
  • deprived
  • qualitative
  • early diagnosis
  • medical help seeking
  • barriers
  • primary care
  • qualitative research
  • respiratory medicine (see thoracic medicine)
  • socioeconomic status
  • public health


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