Using a patient-reported history questionnaire to aid decision-making in the lung cancer diagnostic pathway: a single centre observational study of primary care chest X-ray referrals.

Aim: To determine the utility and efficacy of a patient-reported history questionnaire to identify the presence of red flag symptoms indicative of lung cancer.

Materials And Methods: The study site introduced a paper-based screening questionnaire in 2019 to establish the presence of patient-reported red flag symptoms. This retrospective four-week (February 2020) single-centre observational study determined the prevalence of symptoms, compared referrer-reported to patient-reported clinical history, explored the relationship to the chest X-ray (CXR) outcome, and identified those diagnosed with lung cancer in the following two years. A parallel cross-sectional survey of CXR reporters was undertaken to identify the perceived value of the questionnaire in practice.

Results: 1874 CXRs were reviewed, with conflicting clinical history between referrer and patient evident. 1488 (83.4%) met the red flag criteria, confirming these to be over-sensitive. The diagnostic pathway, measured by the report turnaround time, was quicker for those meeting the red-flag criteria (P < .001), and significantly more likely to identify lung cancer (P < .005). 111 computed tomography (CT) scans were performed, with 17 primary lung cancers diagnosed. 10 additional lung cancers were identified in the following two-years. The majority of reporters utilised the screening questionnaire to aid decision-making.

Conclusion: Given the difficulty in early detection of lung cancers, utilising patient-reported clinical history can provide an opportunity to identify at-risk symptomatic patients, enable appropriate prioritisation of image reporting, and improve timely diagnosis.