Table 2.
Illustrative quotes (qualitative interviews)
| Theme | Quote |
| Symptom detection strategies and help seeking | |
| Friends and family notice symptoms | “My daughter might [notice changes to symptoms] cos she mentions it now and then…she’ll give me a dig and she’ll say ‘your breathing’s annoying me’. Cos it’s heavy breathing so then again there’s something wrong”. (Male, 48, Scotland, former smoker) |
| Sophisticated symptom detection strategies/monitoring of chest infections | “If [phlegm is] white and bubbly it’s not a chest infection. It’s only when it goes green so you can tell yourself exactly how close you are to getting an infection… There’s just two different kinds of green spittle, if it’s fluorescent green then you’ve got an infection, normal antibiotics won’t work with me, if it’s the lighter green I’m fine with that one… it’s handy to look out for, because you can get the right medication at the right time…because if anything happens to me, there’s no one for my kids”. (Female, 48, Scotland, current smoker) |
| Normalisation of haemoptysis | “Coughing up blood, I do actually get some of that I don’t know why, but it could be because of the ulcer thing and that…There again then, well I do get like nosebleeds, and then I’m thinking the blood maybe coming inside and coming down, you swallow it see. So then that will come back up won’t it”. (Male, 62, Wales, former smoker) |
| Focus on maintaining health in the short term | “I get worried about having chest infection, I get more worried about today or tomorrow rather than the future. The future that’s going ahead for us anyway. Lung cancer’s not an issue really”. (Male, 50, Scotland, former smoker) |
| Fear of bad news during a consultation | “I’m very poor in asking questions cos I don’t want to know the results. Simple as that…no I don’t ask when they say the oxygen [saturation] is alright I just think well it’s alright and it’s one thing less I haven’t got to worry about”. (Female, 69, Wales, former smoker) |
| Avoidance of long-term health outcomes | |
| Scepticism about the link between smoking and lung cancer | “You hear occasions where people who don’t smoke, who’ve never smoked. Well how do they get their lung cancer?…I’ve got [lung cancer] in my head, I’m probably going to get it, if I haven’t already got it because of the lifestyle I’ve had. Where I’ve worked and everything else, what I’ve worked with". (Male, 68, England, current smoker) |
| Perceived inevitability of lung cancer/anticipate suicide | “[Lung cancer] is really, really on the forefront on the mind…I just think ‘oh god, please don’t let me get cancer’…I think if I was to get cancer, I’ve sometimes said to myself, I’d commit suicide. I would take a pill or something”. (Female, 81, Scotland, current smoker) |
| Avoidance of lung cancer due to social and contextual factors | “[Lung cancer] worries me but I’ve got proper problems to worry about [carer for disabled son, problems with social services and benefits claims, insecurity of current council owned housing and problems with area of residence with ‘junkies’]. I won’t worry about it until it’s actually here. If I started worrying about eventualities I’d never get anywhere”. (Female, 48, Scotland, current smoker) |
| Lung cancer fatalism/anticipated refusal of treatment | “Until anything happened and I’m actually told that I’ve got [lung cancer], there’s nothing I can do about it. I’m really a believer of what’s in your cards is already written. So I don’t look at anything like that…But if they told me it was cancer, I would go ok then, but I wouldn’t take any of the treatments…if it’s my time, it’s my time. It just doesn’t, I don’t think I’ve got any more fight in me for all that. I think that would be the last straw for me. So I just live every day as it comes now, I don’t really plan much. So I’m just living in the day, you know. Cos whatever happens, happens anyway”. (Female, 49, Scotland, current smoker) |
| Response to lung cancer symptom/female with dependent family | “I don’t think they can treat [ lung cancer]. You’ve just got to accept it haven’t you…I would go to the doctor [ with a symptom], I think I would like to know how long I had. Not for me but for [ my son] you know. For him…If it was just me I wouldn’t want to know, but because I’ve got him, [ I would] definitely…When I seen the blood I did think to myself, I flushed it away right away…I seen the blood and I thought no, and I thought I’ve got to, you know, because of [ my son]. The only way I would want to know is because of him. If I was by myself I would just say, don’t want to know…Can’t just think about myself I’ve got to think about him as well”. (Female, 68, Scotland, current smoker) |
| The model patient | |
| Perception of healthcare professionals attitude to smokers | “You feel as though you’re an alien because you smoke, you feel as so they just look at you and say ‘urghh’, you know”. (Female, 52, Scotland, current smoker) |
| Critical of people who waste National Health Service (NHS) resources | “I can guarantee if I went this Monday and go next Monday the same people are sitting there. I’m being honest, they’re a drain on society on the NHS, but that’s the way they live…these people that go there are not really ill, I think they’re just seeking attention”. (Male, 78, England, current smoker) |
| Relationship with healthcare professional | |
| Disclosure of highly sensitive personal problem |
“Some people are friendly and not stony faced…if (the HCP) can’t even start a conversation with the simplest of ice breakers then how can people tell about pooping themselves when they’re coughing up”. (Female, 48, Scotland, current smoker) |
| Good relationship with GP | “I’m alright with (one GP), you could tell her anything, I’ve shocked her sometimes”. (Female, 51, England, current smoker) |