Document Type
Journal Article
Publication Title
Thorax
Publisher
BMJ Publishing Group
School
School of Nursing and Midwifery
RAS ID
30140
Abstract
Background: International research has focused on screening and mass media campaigns to promote earlier patient presentation and detect lung cancer earlier. This trial tested the effect of a behavioural intervention in people at increased risk of lung cancer on help-seeking for respiratory symptoms.
Methods: Parallel, individually randomised controlled trial. Eligible participants were long-term smokers with at least 20 pack-years, aged 55 and above. The CHEST intervention entailed a consultation to discuss and implement a self-help manual, followed by self-monitoring reminders to encourage help-seeking for respiratory symptoms. The control group received a brief discussion about lung health. Both groups had baseline spirometry. Telephone randomisation was conducted, 1:1, stratified Medical Research Council (MRC) dyspnoea score and general practice. Participants could not be blinded; data extraction and statistical analyses were performed blinded to group assignment. The primary outcome was respiratory consultation rates.
Results: We randomised 551 participants (274 intervention, 277 control) from whom the primary outcome was determined for 542 (269 intervention, 273 control). There was a 40% relative increase in respiratory consultations in the intervention group: (adjusted rates (95% CI) intervention 0.57 (0.47 to 0.70), control 0.41 (0.32 to 0.52), relative rate 1.40 (1.08 to 1.82); p=0.0123). There were no significant differences in time to first respiratory consultation, total consultation rates or measures of psychological harm. The incremental cost-effectiveness ratio was $A1289 per additional respiratory consultation.
Conclusions: A behavioural intervention can significantly increase consulting for respiratory symptoms in patients at increased risk of lung cancer. This intervention could have an important role in primary care as part of a broader approach to improve respiratory health in patients at higher risk. © 2019 Author(s) (or their employer(s)).
DOI
10.1136/thoraxjnl-2018-212506
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Comments
Emery, J. D., Murray, S. R., Walter, F. M., Martin, A., Goodall, S., Mazza, D., . . . Murchie, P. (2019). The chest Australia trial: A randomised controlled trial of an intervention to increase consultation rates in smokers at risk of lung cancer. Thorax, 74(4), 362-370. Available here.