Background
Methods
Study design
Source and study population
Location | SES | Age group | Never smoker | Former smoker | Current smoker |
---|---|---|---|---|---|
Metropolitan | Low | 40-64 years | Group 6 | Group 12 | Group 11 |
65+ years | Group 4 | Group 3 | |||
Medium-high | 40-64 years | Group 1 | Group 2 | ||
65+ years | Group 5 | ||||
Regional | Low | 40-64 years | Group 9 | Group 8 | Group 10 |
65+ years | Group 14 | ||||
Medium-high | 40-64 years | Group 16 | Group 13 | ||
65+ years | Group 15 | Group 7 |
Discussion question | Theme |
---|---|
What do you know about lung cancer? | Knowledge about lung cancer, diagnosis, treatment, prognosis |
What do you think increases someone’s chance of developing lung cancer? | Knowledge & perceptions about causes |
Is there something you could do to reduce/prevent lung cancer? What do you think causes lung cancer? | Knowledge & perceptions about causes |
What symptoms and warning signs do you think could be associated with lung cancer? | Knowledge & perceptions about sentinel symptoms |
What do you think when you hear someone has lung cancer? | Perceived severity and prognosis |
Who do you think is most likely to develop lung cancer? | Perceived risk & susceptibility |
Do you think that you are at risk of developing lung cancer? | Perceived risk & susceptibility |
What would you do if you had symptoms consistent with lung cancer? | Help-seeking behaviours |
Procedure
Qualitative research
Quantitative research
Measures/operational definitions
Data collection & quality control
Analysis
Content and thematic analysis
Statistical analysis
Integration
Results
Qualitative
Knowledge and uncertainty
“You can cough up blood and that’s something else, probably”. -40–55, S, metro
“You’re guessing about a multitude of things between your mouth and the bottom of your lungs, and there’s any number of things that can make you bleed or cough”. - 40–64, ex-S, regional
"Isn't emphysema the start of lung cancer?" 40–65+, S/Ex-S, metro/regional
Help-seeking
“Life experience teaches us something, you know your own body when you get to our age”. -65+, ex-S, metro
“No, otherwise you’d be going to the doctor every day of your life”. - 45–64, NS, metro
Barriers to help seeking
“If you know it’s self-inflicted, you’re less likely to go until you really have to”. - 45–64, ex-S, regional
“Possibly a feeling that the doctor is going to focus on your smoking “don’t bother coming back until you’ve fixed your smoking”. - 65+, S, regional
Down-playing risk
“We are so surrounded by many other toxins it’s impossible to isolate cigarettes only”. - 65+, S, metro
“We know the facts, yet we still smoke. So we’re obviously in denial about a lot of things. We can accept one point of view and another, because we’re playing mind games with ourselves”. - 50–64, S, regional
“By cutting down, eating well and living healthily I’m reducing my risk”. - 50–64, S, regional
“I have a feeling they say 10 years you come back, you got it [the effects of smoking] out of your system”. - 40–64, ex-S, regional
“They say after three months it’s already clearing”. - 65+, ex-S, metro
Uncertainty about cancer causation
“The basic question is why does cancer strike one person and not someone else? …Am I going to get it? We used to think cancer was catching” - 65+, ex-S, regional
“Can they trigger that down or narrow that down to find out what disposition makes someone susceptible to it or any other cancer?” - 45–64, ex-S, metro
“I think we all are (susceptible). I think it’s up us to look after ourselves and get as much exercise” - 45–64, NS, metro
Quantitative
Number | Percent | |
---|---|---|
(unweighted) | (weighted) | |
Sex: | ||
Female | 612 | 54.4 |
Male | 388 | 45.6 |
Age group:
| ||
40-64 years | 466 | 67.7 |
65 years and older | 534 | 32.3 |
Index of relative socio-economic disadvantage:
| ||
1—3 (least disadvantaged) | 529 | 53.5 |
4—5 (most disadvantaged) | 470 | 46.5 |
Education/income combined into socio-economic status:
| ||
Lowest SES | 355 | 39.2 |
Intermediate SES | 138 | 18.7 |
Highest SES | 245 | 42.1 |
Location:
| ||
Regional | 400 | 40.1 |
Metropolitan | 600 | 59.9 |
Smoking status:
| ||
Current smoker | 141 | 11.8 |
Former smoker | 459 | 30.5 |
Never smoked | 400 | 57.8 |
Pack years of smoking:
| ||
Less than or equal to 10 pack years | 157 | 54.0 |
More than 10 pack years | 159 | 46.0 |
Total years of smoking:
| ||
Less than or equal to 20 years | 286 | 48.9 |
More than 20 years | 309 | 51.0 |
Previous experience of cancer:
| ||
Self/family/friend with cancer | 741 | 74.5 |
No close cancer experience | 257 | 25.5 |
Knowledge of risk factors
Quantitative survey responses | Qualitative focus group responses | ||||||
---|---|---|---|---|---|---|---|
Perceived risk factor for lung cancer | Total (%) 95 % confidence interval | Current smokers (%) | Former smokers (%) | Never smokers (%) | Overall | Count | Comparison |
Being a smoker | 90.6 (88.4-92.8) | 86.6 | 89.7 | 91.9 | No observed differences between group discussions based on age, geography. | 13 groups mention smoking, those that didn’t were all smoker groups |
The link with smoking is very well known and people just ignore that and just keep on coughing away.
|
Second-hand smoke | 25.6 (22.3-28.9) | 14.4** | 23.3 * | 29.1 | 7 groups mention passive smoking, those that didn’t were current/exsmoker |
I think certain people are more allergic to nicotine than what otherpeople are.
| |
Air pollution | 21.6 (18.5-24.8) | 28.1 * | 22.3 | 20.0 | The majority of discussions focused around smoking as a cause and its comparability to other potential factors. | 11 groups mention air pollution |
Look if you’re taking anything into your lungs which isn’t clean air, obviously that’s going to have some e effect.
|
Chemicals & sprays | 24.4 (21.1-27.6) | 30.8 | 23.9 | 23.3 | 7 groups mention chemical substances such as poisons, dyes, fertilisers |
Probably the toothpaste has worse chemicals than all of them.
| |
Asbestos | 15.3 (12.6-17.9) | 17.3 | 12.4 | 16.4 | There was confusion about whether it was chance that some people were more susceptible to lung cancer. | 8 groups mention pollution |
Like asbestos and that … anything that can affect the lungs and your breathing.
|
Occupational exposure | 4.9 (3.1-6.7) | 2.6 | 3.9 | 5.9 | 8 groups mention occupation |
People working in coal mines could be at risk of lung disease. People working at a chemical plant.
| |
Hereditary | 13.1 (10.8-15.8) | 16.9 | 14.2 | 12.2 | All groups mention a ‘genetic predisposition’ |
I do believe that everybody is carrying a cancer gene but it has to have something to activate it.
| |
Unhealthy lifestyle | 14.1 (11.5-16.7) | 13.8 | 12.5 | 150 | Stress, physical inactivity, overweight and unhealthy lifestyles were mentioned by different groups |
Yeah, exactly, and I think if a lot of us paid more attention to our fitness, maybe cancer wouldn’t be quite so common.
| |
Diet
|
7.0 (5.0-9.0)
|
5.1
|
3.5 *
|
9.3
| 9 groups believe diet is a cause of lung cancer |
Food and diet additives, preservatives, chemicals in food.
|
Symptom recognition
Quantitative survey responses | Qualitative focus group responses | ||||||
---|---|---|---|---|---|---|---|
What are the warning signs of lung cancer?
| |||||||
Recognition of symptom | Total (%) | Current smokers (%) | Former smokers (%) | Never smokers (%) | Overall | Count | Comparison |
95% confidence interval | |||||||
A painful cough | 23.6 (20.4-26.8) | 26.5 | 21.6 | 24.1 | Most understood that these symptoms could be typical of other health conditions, such as respiratory conditions or emphysema | All groups mention cough but the majority were not able to be specific |
There’s cough and there’s cough…when you’re persistently [coughing] it’s a sign of cancer.
|
Worsening cough | 6.3 (4.5-8.1) | 5.3 | 6.3 | 6.5 |
The kind of cough that comes from way down.
| ||
A persistent cough | 17.0 (14.3-19.7) | 14.6 | 19.0 | 16.5 |
A persistent cough, non-stop, sort of thing. It’s been on for days and weeks on end.
| ||
Persistent chest infection | 1.9 (0.8-2.9) | 0.4 | 0.6 | 2.3 | Only two mention symptom |
Vulnerable to infection.
| |
Coughing up blood | 39.1 (35.4-42.7) | 43.5 | 37.9 | 38.8 | All groups mention symptom |
You can cough up blood and that’s something else, probably.
| |
Shortness of breath | 55.5 (51.9-59.2) | 56.5 | 54.9 | 55.7 | Most groups mention symptom |
On the ad on telly they say you can hear lung cancer before you can see it.
| |
Chest pain | 10.4 (8.1-12.7) | 9.8 | 10.4 | 10.4 | Most groups mention symptom |
Things in the back of the chest.
| |
Loss of weight/appetite | 3.0 (1.8-4.3) | 1.3 | 3.4 | 3.2 | 4 groups mentioned weight loss, only one, mentions appetite |
A dramatic loss of weight.
|
Failure to recognize any symptom
|
Failure to recognise cough
| ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
All participants
|
Smokers only
|
All participants
|
Smokers only
| ||||||||||
N | Odds ratio | 95 % CI |
p value | Odds ratio | 95 % CI |
p value | Odds ratio | 95 % CI |
p value | Odds ratio | 95 % CI |
p value | |
Age group:
| |||||||||||||
65 years and older | 677 | 1 | 1 | 1 | 1 | ||||||||
40-64 years | 323 | 0.55 | 0.33-0.91 | 0.02 | 0.27 | 0.15-0.52 | 0.000 | 0.85 | 0.59-1.21 | 0.4 | 0.63 | 0.40-0.98 | 0.05 |
Sex: | |||||||||||||
Female | 544 | 1 | 1 | 1 | 1 | ||||||||
Male | 456 | 2.07 | 1.20-3.59 | 0.009 | 1.70 | 0.93-3.09 | 0.08 | 1.59 | 1.11-2.27 | 0.01 | 1.48 | 0.97-2.27 | 0.07 |
Smoking status (2 categories):
| |||||||||||||
Never smoked | 578 | 1 | - | - | - | 1 | - | - - | |||||
Ever smoked daily or weekly | 422 | 0.76 | 0.45-1.27 | 0.7 | 1.04 | 0.73-1.47 | 0.8 | 0.7 | |||||
Index of relative socio-economic disadvantage:
| |||||||||||||
1—3 (least disadvantaged) | 535 | 1 | 1 | 1 | 1 | 0.7 | |||||||
4—5 (most disadvantaged) | 465 | 0.87 | 0.43-1.79 | 0.7 | 1.03 | 0.42-2.52 | 0.9 | 0.93 | 0.59-1.46 | 0.7 | 0.89 | 0.53-1.52 | |
Education/income combined into socio economic status:
| |||||||||||||
Lowest SES | 289 | 1 | 1 | 1 | 1 | ||||||||
Intermediate SES | 138 | 0.68 | 0.34-1.42 | 0.3 | 0.57 | 0.26-1.26 | 0.2 | 1.46 | 0.91-2.35 | 0.1 | 1.47 | 0.80-2.71 | 0.2 |
Highest SES | 311 | 0.62 | 0.33-0.19 | 0.2 | 0.65 | 0.29-1.43 | 0.3 | 0.99 | 0.64-1.53 | 0.9 | 0.97 | 0.57-1.66 | 0.9 |
Previous experience of cancer:
| |||||||||||||
Self/family/friend with cancer | 744 | 1 | 1 | 1 | 1 | ||||||||
No close cancer experience | 255 | 0.83 | 0.46-1.50 | 0.5 | 1.28 | 0.68-2.40 | 0.4 | 0.77 | 0.51-1.15 | 0.2 | 1.34 | 0.88-2.12 | 0.2 |
Location based on final postcode:
| |||||||||||||
Regional | 401 | 1 | 1 | 1 | 1 | ||||||||
Metropolitan | 599 | 1.47 | 0.72-3.001 | 0.3 | 2.11 | 0.81-5.44 | 0.1 | 1.51 | 0.96–2.38 | 0.08 | 1.62 | 1.0–2.6 | 0.08 |
Years of smoking:
| |||||||||||||
Less than or equal to 20 years | 291 | - | - | - | 1 | - | - | - | 1 | ||||
More than 20 years | 304 | 1.80 | 0.96-3.36 | 0.07 | 1.37 | 0.88–2.12 | 0.2 | ||||||
Goodness of fit test for model
| 0.390 | 0.191 | 0.236 | 0.678 | |||||||||
(p<0.05 indicates poor fit) |