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

doi:10.3399/bjgp13X660779

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Figure 1
Recruitment to the randomised trial and parallel qualitative study.
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Figure 2
Trial profile.

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Table 1.

Characteristics of participants randomised

Characteristic	Intervention (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 breath	9 (8)	7 (7)
1: only on strenuous exercise	21 (20)	29 (27)
2: on hurrying or walking up slight hill	42 (40)	32 (30)
3: makes walking slower or with stops	16 (15)	8 (8)
4: stops after 100 yards on level	16 (15)	28 (26)
5: housebound with breathlessness	2 (2)	2 (2)
Employment, n (%)
Full time	17 (17)	16 (15)
Part-time work	9 (9)	10 (10)
Unemployed	4 (4)	4 (4)
Retired	58 (58)	56 (54)
Other, such as invalid/disabled/carer	12 (12)	18 (17)
Missing	6	2
Highest educational qualification, n (%)
School leaving certificate to A level	28 (29)	33 (31)
Vocational/technical qualifications	21 (21))	20 (19)
University degree	5 (5)	4 (4)
Other	9 (9)	10 (10)
None of these	35 (34)	38 (36)
Missing	8	1
Scottish Index of Multiple Deprivation, n (%)
1: most deprived	23 (22)	20 (19)
2	27 (25)	38 (36)
3	23 (22)	23 (22)
4	16 (15)	10 (9)
5: least deprived	17 (16)	15 (14)
Home ownership, n (%)
Own home	66 (65)	59 (59)
Rent home	31 (31)	41 (41)
Other	4 (4)	6 (6)
Missing	5 (5)	–
Living arrangements, n (%)
Alone	30 (29)	37 (35)
With spouse/partner	62 (60)	67 (63)
With other family	7 (7)	2 (2)
Other	4 (4)	0 (0)
Missing	3 (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 analysis^a

General practice consultations	Consultations, n	Consulters, n (%)	Consultations, n	Consulters, n (%)	Unadjusted RR ratio (95% CI)	RR (95% CI)	P-value
New chest symptom
Year before	98	45 (44)	118	55 (53)
Year after	138	56 (55)	112	53 (51)	1.26 (0.98 to 1.61)	1.19 (0.92 to 1.53)	0.18
Any chest symptom
Year before	137	45 (44)	145	55 (53)
Year after	188	56 (55)	139	54 (52)	1.38 (1.11 to 1.72)	1.20 (0.96 to 1.51)	0.11
Anxiety or depression
Year before	22	8 (8)	27	15 (14)
Year after	22	13 (13)	33	14 (13)	0.68 (0.40 to 1.17)	0.51 (0.27 to 0.93)	0.029
	Median (IQR)			Median (IQR)
Any reason
Year before	745	6 (4–10)	851	7 (5–10.5)
Year after	833	8 (4–11)	787	7 (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)	Intervention		Control		Unadjusted model		Adjusted model^a

	n	Mean (SD)	n	Mean (SD)	DD	(95% CI)	DD	(95% CI)	P-value
All four scenarios combined
Baseline	102	124 (154)	101	118 (113)
1 month	86	66 (88)	89	102 (116)	–31	(–62.6 to 0.65)	–30.6	(–54.4 to –6.82)	0.012
6 months	89	70 (108)	83	94 (110)	–26.8	(–59.2 to 5.53)	–24.9	(48.3 to –1.47)	0.037
New persistent dry cough
Baseline	105	33 (52)	104	33 (47)
1 month	88	18 (37)	89	24 (40)	–3.73	(–15.1 to 7.60)	–3.27	(–12.8 to 6.26)	0.50
6 months	89	21 (39)	86	26 (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
Baseline	104	35 (54)	104	27 (42)
1 month	87	16 (29)	89	23 (38)	–4.85	(–14.9 to 5.18)	–6.61	(–14.0 to 0.74)	0.078
6 months	89	17 (33)	84	21 (35)	–5.05	(–15.2 to 5.08)	–7.38	(–15.3 to 0.57)	0.069
Coughing up phlegm with signs of blood
Baseline	104	7.4 (20)	103	5.5 (10)
1 month	89	3.6 (5.2)	89	4.4 (5.4)	–6.61	(–14.0 to 0.74)	0.16	(–2.22 to 2.55)	0.89
6 months	90	5.5 (19)	84	4.0 (4.6)	–7.38	(–15.3 to 0.57)	1.23	(–1.00 to 3.46)	0.28
Losing weight
Baseline	105	48 (56)	103	56 (61)
1 month	88	30 (42)	89	51 (59)	–21.1	(–36.2 to –6.00)	–16.9	(–30.3 to3.53)	0.014
6 months	90	25 (36)	83	42 (50)	–16.9	(–29.8 to –4.02)	–11.5	(–22.6 to –0.50)	0.041
Self-efficacy (score from 10 to 100)
Baseline	95	69.7 (23.7)	99	73.5 (19.0)
1 month	83	74.4 (22.0)	82	74.5 (16.8)	–0.27	(–6.20 to 5.66	2.81	(–2.42 to 8.04)	0.29
6 months	86	71.5 (19.8)	76	76.8 (15.5)	–4.00	(–9.43 to 1.44)	–1.54	(–6.45 to 3.37)	0.54
Knowledge (% correct)
Baseline	106	68.4 (22.2)	106	68.9 (24.0)
1 month	90	74.7 (17.4)	90	64.4 (20.4)	10.5	(4.90 to 16.0)	10.4	(5.32 to 15.6)	<0.001
6 months	91	69.1 (18.0)	85	67.0 (23.2)	2.00	(–4.111 to 8.11)	2.03	(–3.86 to 7.92)	0.50
Perceived risk (score out of 5)
Baseline	105	3.27 (1.01)	103	3.39 (0.89)
1 month	89	3.22 (1.04)	87	3.33 (0.95)	–0.13	(–0.43 to 0.16)	–0.05	(–0.28 to 0.18)	0.68
6 months	90	3.23 (0.98)	84	3.25 (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)
Baseline	106	8.38 (2.87)	104	8.84 (2.85)
1 month	90	9.56 (3.69)	88	9.93 (3.73)	–0.39	(–1.47 to 0.68)	–0.014	(–0.81 to 0.78)	0.97
6 months	89	9.52 (3.25)	84	9.14 (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)
Baseline	104	4.63 (3.52)	104	5.69 (4.30)
1 month	89	5.11 (3.61)	90	5.96 (4.08)	–0.68	(–1.81 to 0.44)	0.04	(–0.70 to 0.78)	0.92
6 months	89	5.29 (3.63)	85	5.72 (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)
Baseline	105	5.01 (3.44)	106	5.86 (4.06)
1 month	89	5.55 (3.61)	89	6.21 (3.81)	–0.52	(–1.59 to 0.56)	0.06	(–0.67 to 0.80)	0.86
6 months	90	5.44 (3.45)	85	6.28 (3.89)	0.86	(–1.93 to 0.20)	–0.19	(–0.89 to 0.51)	0.59