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Research

Reducing the time before consulting with symptoms of lung cancer: a randomised controlled trial in primary care

Sarah Smith, Shona Fielding, Peter Murchie, Marie Johnston, Sally Wyke, Rachael Powell, Graham Devereux, Marianne Nicolson, Una Macleod, Phil Wilson, Lewis Ritchie, Amanda J Lee and Neil C Campbell
British Journal of General Practice 2013; 63 (606): e47-e54. DOI: https://doi.org/10.3399/bjgp13X660779
Sarah Smith
Roles: research assistant
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Shona Fielding
Roles: lecturer in medical statistics
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Peter Murchie
Roles: senior lecturer
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Marie Johnston
Roles: professor in health psychology, Aberdeen Health Psychology Group
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Sally Wyke
Roles: interdisciplinary professor
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Rachael Powell
Roles: Cancer research UK academic research fellow
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Graham Devereux
Roles: professor
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Marianne Nicolson
Roles: consultant medical oncologist
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Una Macleod
Roles: professor
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Phil Wilson
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Lewis Ritchie
Roles: Mackenzie Professor of General Practice
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Amanda J Lee
Roles: professor of medical statistics, Division of Applied Health Sciences
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Neil C Campbell
Roles: reader, Centre of Academic Primary Care
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Article Figures & Data

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    Figure 1

    Recruitment to the randomised trial and parallel qualitative study.

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    Figure 2

    Trial profile.

Tables

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    Table 1.

    Characteristics of participants randomised

    CharacteristicIntervention (n = 106)Control (n = 106), n (%)
    Practice A, n (%)51 (48)51 (48)
    Practice B, n (%)55 (52)55 (52)
    Male, n (%)61 (58)64 (61)
    Mean age, years (SD)64.2 (6.0)64.6 (7.0)
    Current smoker, n (%)45 (42)55 (52)
    Chronic obstructive pulmonary disease, n (%)30/102 (29)23/104 (22)
    MRC dyspnoea grade, n (%)
     0: no shortness of breath9 (8)7 (7)
     1: only on strenuous exercise21 (20)29 (27)
     2: on hurrying or walking up slight hill42 (40)32 (30)
     3: makes walking slower or with stops16 (15)8 (8)
     4: stops after 100 yards on level16 (15)28 (26)
     5: housebound with breathlessness2 (2)2 (2)
    Employment, n (%)
     Full time17 (17)16 (15)
     Part-time work9 (9)10 (10)
     Unemployed4 (4)4 (4)
     Retired58 (58)56 (54)
     Other, such as invalid/disabled/carer12 (12)18 (17)
     Missing62
    Highest educational qualification, n (%)
     School leaving certificate to A level28 (29)33 (31)
     Vocational/technical qualifications21 (21))20 (19)
     University degree5 (5)4 (4)
     Other9 (9)10 (10)
     None of these35 (34)38 (36)
     Missing81
    Scottish Index of Multiple Deprivation, n (%)
     1: most deprived23 (22)20 (19)
     227 (25)38 (36)
     323 (22)23 (22)
     416 (15)10 (9)
     5: least deprived17 (16)15 (14)
    Home ownership, n (%)
     Own home66 (65)59 (59)
     Rent home31 (31)41 (41)
     Other4 (4)6 (6)
     Missing5 (5)–
    Living arrangements, n (%)
     Alone30 (29)37 (35)
     With spouse/partner62 (60)67 (63)
     With other family7 (7)2 (2)
     Other4 (4)0 (0)
     Missing3 (3)–
    • MRC = Medical Research Council. SD = standard deviation.

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    Table 2

    Consultation rates during the year before and after the nurse consultation or matched control date

    Intervention (n = 102)Control (n = 104)Adjusted analysisa
    General practice consultationsConsultations, nConsulters, n (%)Consultations, nConsulters, n (%)Unadjusted RR ratio (95% CI)RR (95% CI)P-value
    New chest symptom
     Year before9845 (44)11855 (53)
     Year after13856 (55)11253 (51)1.26 (0.98 to 1.61)1.19 (0.92 to 1.53)0.18
    Any chest symptom
     Year before13745 (44)14555 (53)
     Year after18856 (55)13954 (52)1.38 (1.11 to 1.72)1.20 (0.96 to 1.51)0.11
    Anxiety or depression
     Year before228 (8)2715 (14)
     Year after2213 (13)3314 (13)0.68 (0.40 to 1.17)0.51 (0.27 to 0.93)0.029
    Median (IQR)Median (IQR)
    Any reason
     Year before7456 (4–10)8517 (5–10.5)
     Year after8338 (4–11)7877 (4–10)1.08 (0.98 to 1.19)1.15 (1.04 to 1.27)0.005
    • IQR = interquartile range. RR = rate ratio

    • ↵a Adjusted analysis included age, sex, and practice.

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    Table 3.

    Intention, self-efficacy, knowledge, and mood before intervention and 1 and 6 months afterwards

    Intention to consult (days before consulting)InterventionControlUnadjusted modelAdjusted modela
    nMean (SD)nMean (SD)DD(95% CI)DD(95% CI)P-value
    All four scenarios combined
     Baseline102124 (154)101118 (113)
     1 month8666 (88)89102 (116)–31(–62.6 to 0.65)–30.6(–54.4 to –6.82)0.012
     6 months8970 (108)8394 (110)–26.8(–59.2 to 5.53)–24.9(48.3 to –1.47)0.037
    New persistent dry cough
     Baseline10533 (52)10433 (47)
     1 month8818 (37)8924 (40)–3.73(–15.1 to 7.60)–3.27(–12.8 to 6.26)0.50
     6 months8921 (39)8626 (41)–4.80(–16.5 to 6.95)–6.72(–16.7 to 3.27)0.19
    Newly short of breath in day-to-day activities
     Baseline10435 (54)10427 (42)
     1 month8716 (29)8923 (38)–4.85(–14.9 to 5.18)–6.61(–14.0 to 0.74)0.078
     6 months8917 (33)8421 (35)–5.05(–15.2 to 5.08)–7.38(–15.3 to 0.57)0.069
    Coughing up phlegm with signs of blood
     Baseline1047.4 (20)1035.5 (10)
     1 month893.6 (5.2)894.4 (5.4)–6.61(–14.0 to 0.74)0.16(–2.22 to 2.55)0.89
     6 months905.5 (19)844.0 (4.6)–7.38(–15.3 to 0.57)1.23(–1.00 to 3.46)0.28
    Losing weight
     Baseline10548 (56)10356 (61)
     1 month8830 (42)8951 (59)–21.1(–36.2 to –6.00)–16.9(–30.3 to3.53)0.014
     6 months9025 (36)8342 (50)–16.9(–29.8 to –4.02)–11.5(–22.6 to –0.50)0.041
    Self-efficacy (score from 10 to 100)
     Baseline9569.7 (23.7)9973.5 (19.0)
     1 month8374.4 (22.0)8274.5 (16.8)–0.27(–6.20 to 5.662.81(–2.42 to 8.04)0.29
     6 months8671.5 (19.8)7676.8 (15.5)–4.00(–9.43 to 1.44)–1.54(–6.45 to 3.37)0.54
    Knowledge (% correct)
     Baseline10668.4 (22.2)10668.9 (24.0)
     1 month9074.7 (17.4)9064.4 (20.4)10.5(4.90 to 16.0)10.4(5.32 to 15.6)<0.001
     6 months9169.1 (18.0)8567.0 (23.2)2.00(–4.111 to 8.11)2.03(–3.86 to 7.92)0.50
    Perceived risk (score out of 5)
     Baseline1053.27 (1.01)1033.39 (0.89)
     1 month893.22 (1.04)873.33 (0.95)–0.13(–0.43 to 0.16)–0.05(–0.28 to 0.18)0.68
     6 months903.23 (0.98)843.25 (0.86)0.03(–0.25 to 0.30)0.07(–0.15 to 0.30)0.53
    Cancer Worry Scale (score from 6 to 24)
     Baseline1068.38 (2.87)1048.84 (2.85)
     1 month909.56 (3.69)889.93 (3.73)–0.39(–1.47 to 0.68)–0.014(–0.81 to 0.78)0.97
     6 months899.52 (3.25)849.14 (3.12)0.38(–0.55 to 1.31)0.79(0.16 to 1.41)0.014
    Anxiety (HADS score from 0 to 21)
     Baseline1044.63 (3.52)1045.69 (4.30)
     1 month895.11 (3.61)905.96 (4.08)–0.68(–1.81 to 0.44)0.04(–0.70 to 0.78)0.92
     6 months895.29 (3.63)855.72 (4.12)–0.44(–1.57 to 0.69)0.32(–0.45 to 1.09)0.41
    Depression (HADS score from 0 to 21)
     Baseline1055.01 (3.44)1065.86 (4.06)
     1 month895.55 (3.61)896.21 (3.81)–0.52(–1.59 to 0.56)0.06(–0.67 to 0.80)0.86
     6 months905.44 (3.45)856.28 (3.89)0.86(–1.93 to 0.20)–0.19(–0.89 to 0.51)0.59
    • ↵a Adjusted analysis included baseline score, age group, sex, and practice. DD = days difference. HADS = Hospital Anxiety and Depression Scale.

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British Journal of General Practice: 63 (606)
British Journal of General Practice
Vol. 63, Issue 606
January 2013
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Reducing the time before consulting with symptoms of lung cancer: a randomised controlled trial in primary care
Sarah Smith, Shona Fielding, Peter Murchie, Marie Johnston, Sally Wyke, Rachael Powell, Graham Devereux, Marianne Nicolson, Una Macleod, Phil Wilson, Lewis Ritchie, Amanda J Lee, Neil C Campbell
British Journal of General Practice 2013; 63 (606): e47-e54. DOI: 10.3399/bjgp13X660779

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Reducing the time before consulting with symptoms of lung cancer: a randomised controlled trial in primary care
Sarah Smith, Shona Fielding, Peter Murchie, Marie Johnston, Sally Wyke, Rachael Powell, Graham Devereux, Marianne Nicolson, Una Macleod, Phil Wilson, Lewis Ritchie, Amanda J Lee, Neil C Campbell
British Journal of General Practice 2013; 63 (606): e47-e54. DOI: 10.3399/bjgp13X660779
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Keywords

  • early detection of cancer
  • general practice
  • illness behaviour
  • lung neoplasms
  • randomised controlled trial

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