Patients' help-seeking experiences and delay in cancer presentation: a qualitative synthesis

Smith, Lucy; Pope, Catherine; Botha, J. L.

doi:10.1016/s0140-6736(05)67030-4

Cited by 446 publications

(548 citation statements)

References 40 publications

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“…Both these concepts have been the subject of previous research with patients presenting with cancer or precancer [23][24][25]14 and particularly with younger people in Southern England. 8 Early detection of oral cancer is key to reducing mortality and possible disfigurement, but previous studies have shown that patients delay seeing a health professional after noticing symptoms.…”

Section: Practice Delaymentioning

confidence: 99%

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The experiences of young oral cancer patients in Scotland: symptom recognition and delays in seeking professional help

et al. 2010

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Objectives: To explore the early responses of young oral cancer patients in Scotland to the symptoms of their emerging condition, to understand the ways they seek help and to inquire into delay caused by not recognising symptoms associated with cancer. Setting: The survey was carried out in Maggie's Centres or in patients' own homes in Glasgow and Edinburgh among young patients diagnosed with oral cancer in the three years (2004-7) before the study. Methods: This study employed qualitative methods. Data were collected by interview using a semi-structured interview schedule. The interview transcripts were analysed using a thematic framework and with the aid of NVivo qualitative analysis software (Version 8). Results: Most of the cohort knew that smoking and alcohol could cause oral cancer. None thought it would happen to them. Descriptions of symptoms varied widely and several had used self-treatment provided from a pharmacy. There were various causes of 'patient delay' and self-treatment was not the only cause. Reinterpretation of symptoms without seeking professional help was not uncommon. Nobody suspected they had oral cancer until it was confirmed by their GP or GDP. All thought that something so small and painless couldn't be a serious problem. Conclusions: The study further confirms gaps in understanding and awareness of oral cancer. Most had heard of oral cancer but they didn't think their symptoms were indicative of cancer and they self managed the problem. The culture of not bothering the GP/GDP unless it was perceived as serious is a barrier to earlier access. Findings support that further public awareness of oral cancer and its symptoms is required to alert the public that if their symptoms persist beyond three weeks they need a professional opinion

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Section: Practice Delaymentioning

confidence: 99%

“…Finally, it was apparent from some interviewees that a concern about 'wasting the time' of a health professional or appearing to be a hypochondriac was a factor in delaying consultation -a concern echoed in other studies of delays in cancer presentation. 25 …”

Section: Practice Delaymentioning

confidence: 99%

The experiences of young oral cancer patients in Scotland: symptom recognition and delays in seeking professional help

et al. 2010

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“…However, other research indicates that the raising of additional concerns is a relatively common phenomena. White et al (1994White et al ( , 1997 report additional concerns being raised in 21e23% of consultations but (significantly for the line of argument we shall be developing) note that the more explicit clinicians are about the purpose of the visit, and the nature of the therapeutic regime, the less likely it is that patients will mention additional concerns. The focus on shared decision making in consultations which is a feature of current medical training would also appear to facilitate opportunities for people to bring up more than one concern, and for clinicians to elicit more tangential information from patients in the course of an encounter (See, for example, Peters et al, 2009).…”

Section: Ca Transcription Symbolsmentioning

confidence: 99%

“…In the UK, it appears that the picture is particularly serious, with Corner et al (2006) reporting that delays of up to a year following the onset of worrying symptoms were not uncommon before patients decided to seek medical help. Additionally, high risk groups such as longterm smokers, those living alone, and those with conditions such as Chronic Obstructive Pulmonary Disease (COPD) (Young et al, 2009), have been found to be at particular risk of taking longer to consult with symptoms of lung cancer (Smith et al, 2005). This is significant because in the case of people diagnosed with COPD, the treatment and management of their disease involves frequent interactions with a variety of health care professionals.…”

Section: Introductionmentioning

confidence: 99%

How potentially serious symptom changes are talked about and managed in COPD clinical review consultations: A micro-analysis

Chatwin

Kennedy

Firth

et al. 2014

Social Science & Medicine

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a b s t r a c tPeople with Chronic Obstructive Pulmonary Disease (COPD) are at heightened risk of developing lung cancer. Recent research has suggested that in people who have the disease, the time between symptom onset and consultation can be long enough to significantly affect prognosis. The regular and routine clinical encounters that people with COPD engage in provide an opportunity for them to highlight new symptoms of concern, and for clinicians to be watchful for new symptomatic indicators. We present a micro-analysis of naturalistic data from a corpus of such encounters with the aim of exploring the interactional factors within these routine consultations which influence when and how new symptoms of concern are raised. Our hypothesis is that although the underlying aim of the review consultation is the same in both settings, the different consultation structures oriented to by nurses and GPs have a tangible effect on how new and concerning symptomatic information is introduced. Conversation analysis (CA) was used to examine 39 naturalistic review consultation recordings in two clinical settings; GP led (n ¼ 16), and practice nurse led (n ¼ 23). We describe three interactional formats by which patients chose to present new symptomatic concerns; 'direct', 'embedded', and 'oblique'. Both settings provided interactional 'slots' for patients to offer new and concerning symptomatic information. However, the structure of nurse led encounters tended to limit opportunities for patients to develop extended symptom narratives which in turn facilitated 'oblique' formats. We suggest that the attenuation of the 'oblique' format in this particular clinical setting has implications relating to the psycho-social idiosyncrasies of lung cancer and the maintenance of interactional conditions that encourage patients to disclose new symptomatic concerns.

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“…In India, it evokes a strong emotional response as seen in our day to day practice even amongst many health professionals. Lack of appropriate knowledge, a sense of fear and alienation, financial barriers, prevalent attitudes in the community, inadequate penetration/ poor reach of program activities and socio-cultural factors have been shown to influence the attitudes of the community regarding cancers and affect the cancer control activities adversely (Moore and Spiegel, 2004;Smith et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

A Study on Community Perceptions of Common Cancers, Determinants of Community Behaviour and Program Implementation in New Delhi, India

Seth

Kotwal²,

Thakur³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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Assessment of perceptions of the community, the determinants and development of their behavior regarding common malignancies, helps in establishing evidence-based activities for prevention and early diagnosis of cancer. However information on this important aspect is lacking in our country. Qualitative methods were here used to obtain information through in depth interviews and Focus Group Discussions (FGDs) with all categories of identified stakeholders. Most were unaware of the activities of the cancer control program. Even the providers were not fully conversant. All respondents mentioned lack of diagnostic and treatment facilities in government, primary and secondary level facilities. Perceptions of different categories of stakeholders regarding why many community members did not attend screening camps and other services reflect the determinants of community behavior, acting independently as well as in combination. The cancer control program was thought to be restricted only to some private facilities and overcrowded government tertiary care facilities where the visits were time consuming. Almost all the facilities were considered curative oriented. Issues of supervision, monitoring and feedback were inadequately addressed by providers who were inadequately trained in many program activities. The program lacked effective planning, coordination and appropriate implementation at the grass roots level in Delhi. Social mobilization was grossly inadequate, as most of the community members were unaware of the existence of the program. Misconceptions about the risk factors, signs and symptoms, diagnosis, and treatment were common amongst community members as well as many of the providers. Thus the national cancer control program in our country needs further community participation and social mobilization. Accessibility, availability, acceptability and affordability of various preventive, curative and rehabilitative activities, as well as intersectoral coordination, training, supervision and monitoring of program activities, all need to be addressed to ensure the success of this important public health program.

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Patients' help-seeking experiences and delay in cancer presentation: a qualitative synthesis

Cited by 446 publications

References 40 publications

The experiences of young oral cancer patients in Scotland: symptom recognition and delays in seeking professional help

The experiences of young oral cancer patients in Scotland: symptom recognition and delays in seeking professional help

How potentially serious symptom changes are talked about and managed in COPD clinical review consultations: A micro-analysis

A Study on Community Perceptions of Common Cancers, Determinants of Community Behaviour and Program Implementation in New Delhi, India

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