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Research project: Improving earlier lung cancer diagnosis (Research councils UK Postdoctoral Fellowship 2005 – 2011)

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  The fellowship involved two strands of work.  The first strand developed a symptoms, risks and co-morbidities questionnaire (IPCARD) for use in future prospective studies to obtain predictive values of symptoms for lung cancer diagnosis, and a proposal to evaluate this questionnaire (The IPCARD Feasibility Study - NSPCR funded).  The second strand explored communication about early symptoms to develop symptom elicitation interventions for integration into Clinical Decision Support Aids (CDSAs), and to better understand help-seeking for early LC symptoms.

Development of IPCARD (Identifying Symptoms of Chest and Respiratory Disease) Questionnaire:

Phase 1: Semi-structured interviews with participants with operable lung cancer identified characteristics of early symptoms in this group. Questionnaire items were designed that effectively elicited patient self-report of these symptoms, including health changes normalised and not interpreted as problematic by patients.  A preliminary version of the IPCARD questionnaire was developed that incorporated:

  • A component developed with operable LC patients that uses lay descriptors and open questions to record symptoms and changes in health in ten areas: cough, chest/shoulder pain, breathing, skin condition, joint or bone aches, digestive and bowel changes, weight loss, haemoptysis, voice changes, hoarseness and any other changes in health in the previous two years 
  • Lay descriptors from previous research with late stage lung cancer patients (Corner et al, 2006)
  • Items identified in the International Primary Care Respiratory Group guidelines (Levy et al. 2006) designed to identify COPD and to distinguish between COPD and asthma
  • Lay descriptors of breathlessness identified in studies with patients with asthma, COPD, interstitial lung disease, cardiac failure and lung cancer  (Wilcock et al, 2002)
  • Risk information including smoking history, family history, known occupational exposures and more recently identified risk factors - previous diagnosis of pneumonia or malignancy (Cassidy et al, 2008)
  • Co-morbidities

Phase 2: An iterative process of cognitive interviews followed by changes to the questionnaire, involving 22 patients awaiting lung cancer resection, led to changes to the wording of items and loss of unclear and redundant items. The resultant questionnaire (IPCARD version I) was evaluated and refined with a GP referred Chest X-ray population.

Project Funder


Conferences and Events

Brindle L & Banerjee A. "Do Symptoms of Operable and Inoperable Lung Cancer Differ?: An Interview Study of Symptoms Experienced by Patients Awaiting Lung Cancer Resection" Poster at NIHR Cancer Conference, Liverpool November 2012

Brindle L, Pope C, Corner J et al. "Feeling well despite symptoms: Improving the detection of operable lung cancer by improving GP elicitation of unrecognised symptoms" Poster at NIHR Cancer Conference, Liverpool November 2012

Brindle L. (2007), Deconstructing symptoms: Developing an ethnomethodological understanding of ‘patient delay' in lung cancer diagnosis. Paper at the British Sociological Association medical sociology conference, Liverpool September.

Associated research themes

Early Cancer diagnosis
Clinician-patient communication
Questionnaire development

Related research groups

Complex Healthcare Processes
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