Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
Stockholm Health Care Services (SLSO), Stockholms County Council (SLL), Stockholm, Sweden.
PLoS One. 2021 Mar 29;16(3):e0249114. doi: 10.1371/journal.pone.0249114. eCollection 2021.
Lung cancer (LC) generally lacks unique core symptoms or signs. However, there are a multitude of bodily sensations that are often non-specific, not easily understood, and many times initially not recognized as indicative of LC by the affected person, which often leads to late diagnosis. In this international qualitative study, we inductively analyzed retrospective accounts of 61 people diagnosed with LC in Denmark, England and Sweden. Using the bodily sensations they most commonly spoke about (tiredness, breathlessness, pain, and cough), we constructed four sensation-based cases to understand the pre-diagnostic processes of reasoning and practice triggered by these key indicators of LC. We thereafter critically applied Hay's model of sensations to symptoms transformation, examining its central concepts of duration, disability and vulnerability, to support understanding of these processes. We found that while duration and disability are clearly relevant, vulnerability is more implicitly expressed in relation to perceived threat. Tiredness, even when of long duration and causing disability, was often related to normal aging, rather than a health threat. Regardless of duration, breathlessness was disturbing and threatening enough to lead to care-seeking. Pain varied by location, duration and degree of disability, and thus also varied in degree of threat perceived. Preconceived, but unmet expectations of what LC-related cough and pain would entail could cause delays by misleading participants; if cough lasted long enough, it could trigger health care contact. Duration, disability, and sense of threat, rather than vulnerability, were found to be relevant concepts for understanding the trajectory to diagnosis for LC among these participants. The process by which an individual, their family and health care providers legitimize sensations, allowing them to be seen as potential symptoms of disease, is also an essential, but varying part of the diagnostic processes described here.
肺癌（LC）通常缺乏独特的核心症状或体征。然而，有许多身体感觉往往是非特异性的，不容易理解，很多时候患者最初并没有将其识别为 LC 的迹象，这往往导致诊断较晚。在这项国际定性研究中，我们对丹麦、英国和瑞典的 61 名 LC 患者的回顾性报告进行了归纳性分析。使用他们最常提到的身体感觉（疲劳、呼吸困难、疼痛和咳嗽），我们构建了四个基于感觉的病例，以了解这些 LC 关键指标引发的推理和实践的预诊断过程。随后，我们批判性地应用了 Hay 的感觉向症状转化模型，考察了其持续时间、残疾和脆弱性的核心概念，以支持对这些过程的理解。我们发现，虽然持续时间和残疾显然是相关的，但脆弱性在与感知威胁的关系中更多地被隐含表达。疲劳，即使持续时间长并导致残疾，也往往与正常衰老有关，而不是健康威胁。无论持续时间如何，呼吸困难都会引起不适和威胁，足以导致寻求护理。疼痛因位置、持续时间和残疾程度而异，因此感知到的威胁程度也不同。对 LC 相关咳嗽和疼痛的预期，但未得到满足的期望，可能会通过误导参与者而导致延误；如果咳嗽持续足够长的时间，它可能会引发医疗保健接触。持续时间、残疾和威胁感，而不是脆弱性，被发现是理解这些参与者 LC 诊断轨迹的相关概念。个体、他们的家人和医疗保健提供者使感觉合理化的过程，使它们被视为疾病潜在症状的过程，也是这里描述的诊断过程中一个必不可少但变化的部分。
