151
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Malalasekera A, Dhillon HM, Shunmugasundaram C, Blinman PL, Kao SC, Vardy JL. Why do delays to diagnosis and treatment of lung cancer occur? A mixed methods study of insights from Australian clinicians. Asia Pac J Clin Oncol 2020; 17:e77-e86. [PMID: 32298539 DOI: 10.1111/ajco.13335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 02/29/2020] [Indexed: 12/14/2022]
Abstract
AIMS Delays in lung cancer diagnosis and treatment can impact survival. We explored reasons for delays experienced by patients with lung cancer to identify themes and strategies for improvement. METHODS We used national timeframe recommendations and standardized definitions to identify General Practitioners and specialists caring for 34 patients who experienced delays in our previous Medicare data linkage study. Clinicians participated in a survey and interview, including qualitative (exploratory, open-ended questions) and quantitative (rating scales) components. Exploratory content analysis, cross-case triangulation, and descriptive statistics were performed. Krippendorff's coefficient was used to assess level of agreement between clinicians and patients, and among clinicians, on perceived delays. RESULTS Overall, 27 out of 50 (54%) eligible clinicians participated (including 11 respiratory physicians and seven medical oncologists). Dominant themes for perceived causes of delay included referral barriers, limited General Practitioner (GP) awareness of subtle clinical presentations, insufficient radiology interpretation, and lack of cancer coordinators. "Unavoidable" delays may occur due to clinical circumstances. Awareness and uptake of referral and timeframe guidelines were low, with clinicians using professional networks over guidelines. There was no consistent agreement on perceived delays between patients and clinicians, and among clinicians (Krippendorff's coefficient .03 [P = .8]). CONCLUSIONS Strategies for minimizing avoidable delays include efficient GP to specialist referral and more lung cancer coordinators to assist with patient expectations and waitlist management. Clinicians' reliance on experience, rather than guidelines, indicates need to review guideline utility. Raising awareness of benchmarks and unavoidable barriers may recalibrate perceptions of "delays" to diagnosis and treatment of lung cancer.
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Affiliation(s)
- Ashanya Malalasekera
- Sydney Medical School, University of Sydney, New South Wales, Australia.,Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, New South Wales, Australia
| | - Chindhu Shunmugasundaram
- Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, New South Wales, Australia
| | - Prunella L Blinman
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Steven C Kao
- Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Janette L Vardy
- Sydney Medical School, University of Sydney, New South Wales, Australia.,Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, New South Wales, Australia
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152
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Sarma EA, Rendle KA, Kobrin SC. Cancer symptom awareness in the US: Sociodemographic differences in a population-based survey of adults. Prev Med 2020; 132:106005. [PMID: 32004595 DOI: 10.1016/j.ypmed.2020.106005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 11/27/2019] [Accepted: 01/25/2020] [Indexed: 12/12/2022]
Abstract
Symptom awareness may improve cancer outcomes by prompting timely help-seeking and diagnosis. Research in the UK has shown lower symptom awareness among sociodemographic groups at higher risk of poor cancer outcomes; however, no population-based surveys in the US have assessed whether cancer symptom awareness varies across sociodemographic groups. We therefore examined associations between sociodemographic factors and recognition of 11 cancer symptoms using a novel population-based survey of US adults. We conducted telephone interviews in 2014 with a population-representative sample of English-speaking adults (aged 50 and older) in the US (N = 1425) using an adapted Awareness and Beliefs about Cancer (ABC) survey. Socioeconomic status (SES) was indexed by education. Additional sociodemographic factors included gender, age, marital status, and race. We used multivariable logistic regression models to examine the association between sociodemographic factors and recognition of each symptom, adjusting for cancer experience. Participants recognized an average of 8.43 symptoms as potential signs of cancer. In multivariable analyses, less education consistently predicted lower recognition across the symptoms. As socioeconomic inequalities in cancer mortality widen, it is increasingly important to understand factors that may contribute to these disparities. Our results suggest that US adults of lower SES have lower cancer symptom awareness across symptoms, findings that echo results from other developed countries. With low rates of cancer screening, another approach to reducing cancer burden and disparities may be through greater symptom awareness for symptoms with lower awareness, though additional work is needed to identify mechanisms through which awareness may have its effects on cancer outcomes.
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Affiliation(s)
- Elizabeth A Sarma
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda 20892, MD, USA; Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Bethesda 20892, MD, USA.
| | - Katharine A Rendle
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, 19104, PA, USA
| | - Sarah C Kobrin
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda 20892, MD, USA
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153
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Reconceptualising Rural Cancer Inequalities: Time for a New Research Agenda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041455. [PMID: 32102462 PMCID: PMC7068553 DOI: 10.3390/ijerph17041455] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 12/13/2022]
Abstract
Evidence has shown for over 20 years that patients residing in rural areas face poorer outcomes for cancer. The inequalities in survival that rural cancer patients face are observed throughout the developed world, yet this issue remains under-examined and unexplained. There is evidence to suggest that rural patients are more likely to be diagnosed as a result of an emergency presentation and that rural patients may take longer to seek help for symptoms. However, research to date has been predominantly epidemiological, providing us with an understanding of what is occurring in these populations, yet failing to explain why. In this paper we outline the problems inherent in current research approaches to rural cancer inequalities, namely how ‘cancer symptoms’ are conceived of and examined, and the propensity towards a reductionist approach to rural environments and populations, which fails to account for their heterogeneity. We advocate for a revised rural cancer inequalities research agenda, built upon in-depth, community-based examinations of rural patients’ experiences across the cancer pathway, which takes into account both the micro and macro factors which exert influence on these experiences, in order to develop meaningful interventions to improve cancer outcomes for rural populations.
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154
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Howell D, Hart R, Smith A, Macleod U, Patmore R, Roman E. 'Unpacking' pathways to lymphoma and myeloma diagnosis: Do experiences align with the Model of Pathways to Treatment? Findings from a UK qualitative study with patients and relatives. BMJ Open 2020; 10:e034244. [PMID: 32054627 PMCID: PMC7045052 DOI: 10.1136/bmjopen-2019-034244] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/12/2019] [Accepted: 01/13/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To explore alignment of experiences before lymphoma and myeloma diagnosis with the appraisal, help seeking and diagnostic intervals in the Model of Pathways to Treatment (MPT). DESIGN A qualitative study using in-depth semistructured interviews with patients and relatives. Interviews were transcribed verbatim, anonymised and analysed using qualitative description. SETTING A UK population-based haematological malignancy patient cohort. PARTICIPANTS Fifty-five patients (35 lymphoma, 20 myeloma: diagnosed 2014-2016) and 28 relatives participated, within around a year of the patient's diagnosis. Patients were selected from those in the cohort who had returned a questionnaire about their symptoms and help seeking, and consented to contact for further research. Sampling was purposive, to achieve maximum variation in age, sex and time to diagnosis. RESULTS Participants described time from symptom onset to diagnosis as ranging from several weeks to years. Pathways largely aligned with MPT components and help seeking could lead to the rapid investigations and identification of abnormalities. However, symptoms could be vague and/or inadvertently interpreted as other conditions, which if perpetuated, could cause diagnostic delay. The latter was associated with chaotic pathways, with activities rarely occurring only once or in a linear sequence. Rather, intermittent or ongoing processes were described, moving forward and backwards through intervals. This is 'unpacked' within five themes: (1) appraisal and reappraisal; (2) patient-initiated self-management/treatment; (3) initial help seeking; (4) re-presentation; and (5) patient-initiated actions, decisions and emotions during re-presentation. Within these themes, various healthcare professionals were consulted, often many times, as symptoms persisted/progressed. Input from family/friends was described as substantial, as was the extent to which information seeking occurred. CONCLUSION Lymphoma and myeloma pathways align with the MPT, but do not fully capture the repetition and complexity described by participants. Time to diagnosis was often prolonged, despite the best efforts of patients, relatives and healthcare professionals. The impact of National Health Service England's Multi-diagnostic Disciplinary Centres on time to haematological cancer diagnosis remains to be seen.
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Affiliation(s)
- Debra Howell
- Department of Health Sciences, University of York, York, UK
| | - Ruth Hart
- Department of Health Sciences, University of York, York, UK
| | | | - Una Macleod
- Hull York Medical School, University of Hull, Hull, UK
| | - Russell Patmore
- Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Cottingham, Hull, UK
| | - Eve Roman
- Department of Health Sciences, University of York, York, UK
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155
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Venchiarutti RL, Clark JR, Palme CE, Shakespare TP, Hill J, Tahir ARM, Dwyer P, Young JM. Influence of remoteness of residence on timeliness of diagnosis and treatment of oral cavity and oropharynx cancer: A retrospective cohort study. J Med Imaging Radiat Oncol 2020; 64:261-270. [PMID: 32037663 DOI: 10.1111/1754-9485.12990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/29/2019] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Geographic disparities in head and neck cancer (HNC) outcomes in Australia may be mediated by timeliness of diagnosis and treatment. This retrospective cohort study examines geographic variations in survival and time intervals leading up to treatment for HNC at two tertiary referral centres in New South Wales. METHODS Eligible patients were NSW residents aged ≥18 years, diagnosed with primary oropharynx or oral cavity squamous cell carcinoma (SCC) between 01 July 2008 and 30 June 2013, and treated with curative intent. Main outcomes were times from diagnosis to treatment and from surgery to post-operative radiotherapy and overall survival. Differences based on remoteness of residence (regional/remote or metropolitan) were assessed. RESULTS A total of 224 patients were eligible. Median time from symptom onset to treatment was longer for regional/remote patients with oropharynx SCC (4.7 vs. 3.8 months, P = 0.044) and oral cavity SCC (6.4 vs. 3.3 months, P = 0.003). Median time from diagnosis to treatment was longer for regional/remote patients with oropharyngeal SCC (47 days vs. 36 days, P = 0.003). Time from surgery to adjuvant radiotherapy was longer among regional/remote patients with oral cavity SCC (66 vs. 42 days, P = 0.001). Overall survival did not differ based on remoteness. CONCLUSION Regional/remote HNC patients experienced longer times to diagnosis and treatment, and regardless of remoteness of residence, fewer than half of patients were treated within guideline recommended timeframes. Despite this non-adherence to guidelines, there were no differences in survival outcomes among this cohort. However, the impact of not meeting guidelines on patient outcomes other than survival warrants further investigation.
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Affiliation(s)
- Rebecca L Venchiarutti
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan R Clark
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,RPA Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia.,Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,RPA Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia.,Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Thomas P Shakespare
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
| | - Jacques Hill
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
| | - Abdul Rahim Mohd Tahir
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Patrick Dwyer
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Radiation Oncology, Northern NSW Cancer Institute, Lismore, New South Wales, Australia
| | - Jane M Young
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia.,RPA Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
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156
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Walter FM, Pannebakker MM, Barclay ME, Mills K, Saunders CL, Murchie P, Corrie P, Hall P, Burrows N, Emery JD. Effect of a Skin Self-monitoring Smartphone Application on Time to Physician Consultation Among Patients With Possible Melanoma: A Phase 2 Randomized Clinical Trial. JAMA Netw Open 2020; 3:e200001. [PMID: 32101302 PMCID: PMC7137684 DOI: 10.1001/jamanetworkopen.2020.0001] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Melanoma is among the most lethal skin cancers; it has become the fifth most common cancer in the United Kingdom, and incidence rates are rising. Population approaches to reducing incidence have focused on mass media campaigns to promote earlier presentation and potentially improve melanoma outcomes; however, interventions using smartphone applications targeting those with the greatest risk could promote earlier presentation to health care professionals for individuals with new or changing skin lesions. OBJECTIVE To study the effect of a commercially available skin self-monitoring (SSM) smartphone application among individuals with increased risk of melanoma on their decision to seek help for changing skin lesions. DESIGN, SETTING, AND PARTICIPANTS This phase 2 randomized clinical trial was conducted in 12 family practices in Eastern England between 2016 and 2017. A total of 238 participants, aged 18 to 75 years and with an increased risk of melanoma, were identified using a real-time melanoma risk assessment tool in family practice waiting rooms. Analysis was intention to treat. Participants were observed for 12 months, and data analysis was conducted from January to August 2018. INTERVENTION The intervention and control groups received a consultation with standard written advice on sun protection and skin cancer detection. The intervention group had an SSM application loaded on their smartphone and received instructions for use and monthly self-monitoring reminders. MAIN OUTCOMES AND MEASURES The coprimary outcomes were skin consultation rates with family practice physicians and patient intervals, measured as the time between noticing a skin change and consulting with a family practice clinician. Follow-up questionnaires were sent at 6 and 12 months, and consultation rates were extracted from family practice records. Secondary outcomes included skin self-examination benefits and barriers, self-efficacy for consulting without delay, perceived melanoma risk, sun protection habits, and potential harms. RESULTS A total of 238 patients were randomized (median [interquartile range] age, 55 [43-65] years, 131 [55.0%] women, 227 [95.4%] white British; 119 [50.0%] randomized to the intervention group). Overall, 51 participants (21.4%) had consultations regarding skin changes during the 12 months of follow-up, and 157 participants (66.0%) responded to at least 1 follow-up questionnaire. There were no significant differences in skin consultation rates (adjusted risk ratio, 0.96; 95% CI, 0.56 to 1.66; P = .89), measures of SSM (adjusted mean difference, 0.08; 95% CI, -0.83 to 1.00; P = .86), or psychological harm (eg, Melanoma Worry Scale: adjusted mean difference, -0.12; 95% CI, -0.56 to 0.31; P = .58). CONCLUSIONS AND RELEVANCE In this study, recruitment, retention, and initial delivery of the intervention were feasible, and this research provided no evidence of harm from the SSM smartphone application. However, no evidence of benefit on skin self-examination or health care consulting was found, and there is no reason at this stage to recommend its implementation in this population at increased risk of melanoma. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN16061621.
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Affiliation(s)
- Fiona M. Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Department of General Practice and the Centre for Cancer Research, Faculty of Medicine, Dentistry, and Health Science, Victorian Comprehensive Cancer Centre, University of Melbourne, Australia
| | - Merel M. Pannebakker
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Matthew E. Barclay
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Katie Mills
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Catherine L. Saunders
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Peter Murchie
- Institute of Applied Health Science, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom
| | - Pippa Corrie
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Per Hall
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Nigel Burrows
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Jon D. Emery
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Department of General Practice and the Centre for Cancer Research, Faculty of Medicine, Dentistry, and Health Science, Victorian Comprehensive Cancer Centre, University of Melbourne, Australia
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157
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Heyhoe J, Reynolds C, Lawton R. The early diagnosis of cancer in primary care: A qualitative exploration of the patient's role and acceptable safety-netting strategies. Eur J Cancer Care (Engl) 2019; 29:e13195. [PMID: 31829486 DOI: 10.1111/ecc.13195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 08/28/2019] [Accepted: 11/20/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The study had two aims-to assess the components considered important for patient involvement in diagnosing cancer earlier in primary care and to assess the acceptability, feasibility, cost and burden of three safety-netting interventions in terms of their potential to become a sustainable component of standard care and improve diagnostic outcomes for cancer in a primary care setting. METHOD Fifteen interviews were conducted with patients and GPs/Nurse Practitioners. Findings were fed back at a workshop with 18 stakeholders who helped to conceptualise an intervention. Interviews were analysed using thematic analysis. Stakeholder discussions were captured through group feedback sessions. RESULTS Three key themes around stakeholders' views on patient involvement emerged from the interviews. These were keeping the door open, roles and responsibilities and fear of cancer. Interview findings and workshop feedback identified the intervention should include a verbal discussion and plan, written information and a patient prompt option. CONCLUSION Patient involvement in diagnosing cancer in primary care is considered acceptable to patients and HCPs. Factors that facilitate or hinder involvement have been identified. Components deemed important in a safety-netting intervention, and potential costs and benefits were established. This knowledge can direct future research and the development of safety-netting interventions.
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Affiliation(s)
- Jane Heyhoe
- Bradford Institute for Health Research, Bradford, UK
| | | | - Rebecca Lawton
- Bradford Institute for Health Research, Bradford, UK.,School of Psychology, University of Leeds, Leeds, UK
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158
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Faruqui N, Joshi R, Martiniuk A, Lowe J, Arora R, Anis H, Kalra M, Bakhshi S, Mishra A, Santa A, Sinha S, Siddaiahgari S, Seth R, Bernays S. A health care labyrinth: perspectives of caregivers on the journey to accessing timely cancer diagnosis and treatment for children in India. BMC Public Health 2019; 19:1613. [PMID: 31791308 PMCID: PMC6889559 DOI: 10.1186/s12889-019-7911-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/07/2019] [Indexed: 11/17/2022] Open
Abstract
Background Cure rates for children with cancer in India lag behind that of high-income countries. Various disease, treatment and socio-economic related factors contribute to this gap including barriers in timely access of diagnostic and therapeutic care. This study investigated barriers to accessing care from symptom onset to beginning of treatment, from perspectives of caregivers of children with cancer in India. Methods Semi-structured in-depth interviews were conducted with caregivers of children (< 18 years) diagnosed with cancer in seven tertiary care hospitals across New Delhi and Hyderabad. Purposive sampling to saturation was used to ensure adequate representation of the child’s gender, age, cancer type, geographical location and socioeconomic status. Interviews were audio recorded after obtaining informed consent. Thematic content analysis was conducted and organised using NVivo 11. Results Thirty-nine caregivers were interviewed, where three key themes emerged from the narratives: time intervals to definitive diagnosis and treatment, the importance of social supportive care and the overall accumulative impacts of the journey. There were two phases encapsulating the experiences of the family: referral pathways taken to reach the hospital and after reaching the hospital. Most caregivers, especially those from distant geographical areas had variable and inconsistent referral pathways partly due to poor availability of specialist doctors and diagnostic facilities outside major cities, influence from family or friends, and long travel times. Upon reaching the hospital, families mostly from public hospitals faced challenges navigating the hospital facilities, finding accommodation, and comprehending the diagnosis and treatment pathway. Throughout both phases, financial constraint was a recurring issue amongst low-income families. The caregiver’s knowledge and awareness of the disease and health system, religious and social factors were also common barriers. Conclusion This qualitative study highlights and explores some of the barriers to childhood cancer care in India. Our findings show that referral pathways are intrinsically linked to the treatment experience and there should be better recognition of the financial and emotional challenges faced by the family that occur prior to definitive diagnosis and treatment. This information would help inform various stakeholders and contribute to improved interventions addressing these barriers.
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Affiliation(s)
- Neha Faruqui
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia. .,George Institute for Global Health, Sydney, NSW, Australia.
| | - Rohina Joshi
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Alexandra Martiniuk
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Ramandeep Arora
- Cankids…Kidscan, New Delhi, India.,Max Super Speciality Hospital, New Delhi, India
| | | | - Manas Kalra
- Indraprastha Apollo Hospital, New Delhi, India
| | | | | | - Ayyagari Santa
- Basavatarakam Indo American Cancer Hospital, Hyderabad, India
| | | | | | | | - Sarah Bernays
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,London School of Hygiene and Tropical Medicine, London, UK
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159
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Barbhuiya F. Treatment trajectory of tobacco-related cancer patients: A study in Assam, India. Cancer Epidemiol 2019; 63:101614. [PMID: 31585305 DOI: 10.1016/j.canep.2019.101614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 09/03/2019] [Accepted: 09/18/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND In India, more than half of the total cancer cases are diagnosed at an advanced stage resulting in a high mortality rate. Early diagnosis and proper treatment may result in reduced mortality. Understanding the treatment trajectory followed by a patient is important for reducing diagnostic delay which may result in improved prognosis and treatment. With this background, the current study attempts to understand the treatment-seeking processes of Tobacco-related Cancer (TRC) patients in the state of Assam. METHODS Explanatory Sequential Mixed design was adopted for the study. In the first phase of the study, 100 participants were interviewed using an interview schedule and then 11 in-depth interviews were conducted in the later phase to understand the subject matter in more depth. RESULTS The study revealed that the initial point of contact for seeking help for most of the participants was their family, which was followed by an alternative system of medicine including faith healers and quacks. Participants with a lower level of literacy and economic instability were seen to have approached family members, faith healers and quacks more as compared to the people with a higher level of literacy and economic stability who approached health professionals, friends, and others for initial help-seeking. Also, an association between causal health beliefs and treatment choices of the patients were discovered. CONCLUSIONS The study suggests addressing the beliefs and practices associated with cancer care (both modern and traditional) by engaging mass awareness. Need for designing cancer-education programmes for the general population was also advocated.
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160
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Renzi C, Kaushal A, Emery J, Hamilton W, Neal RD, Rachet B, Rubin G, Singh H, Walter FM, de Wit NJ, Lyratzopoulos G. Comorbid chronic diseases and cancer diagnosis: disease-specific effects and underlying mechanisms. Nat Rev Clin Oncol 2019; 16:746-761. [PMID: 31350467 DOI: 10.1038/s41571-019-0249-6] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 02/06/2023]
Abstract
An earlier diagnosis is a key strategy for improving the outcomes of patients with cancer. However, achieving this goal can be challenging, particularly for the growing number of people with one or more chronic conditions (comorbidity/multimorbidity) at the time of diagnosis. Pre-existing chronic diseases might affect patient participation in cancer screening, help-seeking for new and/or changing symptoms and clinicians' decision-making on the use of diagnostic investigations. Evidence suggests, for example, that pre-existing pulmonary, cardiovascular, neurological and psychiatric conditions are all associated with a more advanced stage of cancer at diagnosis. By contrast, hypertension and certain gastrointestinal and musculoskeletal conditions might be associated with a more timely diagnosis. In this Review, we propose a comprehensive framework that encompasses the effects of disease-specific, patient-related and health-care-related factors on the diagnosis of cancer in individuals with pre-existing chronic illnesses. Several previously postulated aetiological mechanisms (including alternative explanations, competing demands and surveillance effects) are integrated with newly identified mechanisms, such as false reassurances, or patient concerns about appearing to be a hypochondriac. By considering specific effects of chronic diseases on diagnostic processes and outcomes, tailored early diagnosis initiatives can be developed to improve the outcomes of the large proportion of patients with cancer who have pre-existing chronic conditions.
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Affiliation(s)
- Cristina Renzi
- ECHO (Epidemiology of Cancer Healthcare and Outcomes) Research Group, Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, London, UK.
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Aradhna Kaushal
- ECHO (Epidemiology of Cancer Healthcare and Outcomes) Research Group, Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, London, UK
| | - Jon Emery
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Willie Hamilton
- St Luke's Campus, University of Exeter Medical School, Exeter, UK
| | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Bernard Rachet
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Greg Rubin
- Institute of Health and Society, Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Niek J de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
| | - Georgios Lyratzopoulos
- ECHO (Epidemiology of Cancer Healthcare and Outcomes) Research Group, Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, London, UK
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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161
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Al-Azri M, Al-Saadi WI, Al-Harrasi A, Murthi Panchatcharam S. Knowledge of Cancer Risk Factors, Symptoms, and Barriers to Seeking Medical Help among Omani Adolescents. Asian Pac J Cancer Prev 2019; 20:3655-3666. [PMID: 31870107 PMCID: PMC7173372 DOI: 10.31557/apjcp.2019.20.12.3655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Indexed: 12/24/2022] Open
Abstract
Objective: Raising cancer awareness among adolescents should lead to early diagnosis and improve their survival rate into adulthood. This study aims to identify knowledge of cancer risk factors, symptoms and barriers to seek medical help among Omani adolescents. Methods: A cross-sectional study with Omani adolescents (aged 15-17 years) has been conducted in six schools in Muscat, the capital of Oman. The general Cancer Awareness Measure questionnaire was used to collect the data. Results: A total of 481 adolescents participated. The average recognition of cancer risk factors and symptoms was low (36.8% and 39.6%, respectively). Cancer risk factors and/or symptoms significantly recognised more in girls compared to boys (χ2 = 10.136; Odds ratio [OR] = 2.13 ; 95% confidence interval [CI]= 0.33-3.41; P = 0.001); older (age 17 year) versus younger (aged 15 and 16 years) (χ2 = 6.075; OR = 11.68; 95% CI: 1.11-2.53; P = 0.014); those with existing co-morbidities compared to those without (χ2 = 4.955; OR = 0.41; 95% CI: 0.18-0.92; P = 0.026); and those who knew someone with cancer compared to those who did not (χ2 = 15.285; OR 2.70; 95% CI: 1.62-4.49; P <0.001). The majority of adolescents (88.8%) would seek medical help within the first two weeks of noting cancer symptoms. The most notable barriers to seek medical help were “emotional”. Girls were experienced “emotional barriers” significantly more than the boys (χ2 = 11.617; OR = 1.89; 95% CI: 1.31-2.72; P = <0.001). Conclusion: Adolescents in Oman showed poor cancer awareness with several “emotional” barriers. There is a need to establish and integrate effective cancer educational programs in school curriculums to raise the cancer awareness, address emotional barriers and encourage seeking early medical help. The program could potentially have a life-long impact on encouraging early cancer diagnosis and improving the cancer survival rate.
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Affiliation(s)
- Mohammed Al-Azri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman
| | - Waleed Ibrahim Al-Saadi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman
| | - Abdulaziz Al-Harrasi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman
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162
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Momeni M, Rafii F. Help-seeking behaviour for cancer symptoms: an evolutionary concept analysis. Scand J Caring Sci 2019; 34:807-817. [PMID: 31749236 DOI: 10.1111/scs.12788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/09/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cancer survival largely depends on its early diagnosis. Therefore, assessing help-seeking behaviours among people with potential symptoms of cancer is essential. AIM This study aimed to analyse the concept of help-seeking behaviour for cancer symptoms. METHODS This concept analysis was conducted using Rodger's evolutionary method. An online literature search was conducted in the PubMed, Scopus and Cochrane databases to find relevant articles published from 2000 to 2017 in English peer-reviewed journals. In total, ninety articles were included in the study. Through thematic analysis, the data were analysed for the definitions, attributes, antecedents and consequences of the concept of help-seeking behaviour for cancer symptoms. RESULTS The concept of help-seeking behaviour for cancer symptoms includes a chain of behaviours and is defined as the process of informed decision-making for seeking medical help and using healthcare services after the detection of the first potential cancer symptoms. The attributes of the concept of help-seeking behaviour for cancer symptoms include process, problem-centeredness, intentional action and interpersonal interaction. Antecedents of the concept of help-seeking behaviour for cancer symptoms were broadly categorised as its facilitators and barriers, among which old age, young age, marriage, low education level, positive family history of cancer, fear over cancer, low perceived threat, symptom disclosure to significant others are both facilitator and barrier. The consequences of the concept of help-seeking behaviour for cancer symptoms were also broadly categorised in the two main categories of positive consequences and adverse consequences. CONCLUSIONS Help-seeking behaviour is a multidimensional time-dependent and context-bound concept which is usually defined based on the concept of time in order to facilitate its measurement. It is generally used for assessing patients' delay in seeking medical help. The findings of this study provide better understanding about the concept of help-seeking behaviour for cancer symptoms and its implications for research and practice.
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Affiliation(s)
- Maryam Momeni
- Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Forough Rafii
- Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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163
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Non-attendance at urgent referral appointments for suspected cancer: a qualitative study to gain understanding from patients and GPs. Br J Gen Pract 2019; 69:e850-e859. [PMID: 31748378 PMCID: PMC6863680 DOI: 10.3399/bjgp19x706625] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/20/2019] [Indexed: 11/05/2022] Open
Abstract
Background The 2-week-wait urgent referral policy in the UK has sought to improve cancer outcomes by accelerating diagnosis and treatment. However, around 5–7% of symptomatic referred patients cancel or do not attend their hospital appointment. While subsequent cancer diagnosis was less likely in non-attenders, those with a diagnosis had worse early mortality outcomes. Aim To examine how interpersonal, communication, social, and organisational factors influence a patient’s non-attendance. Design and setting Qualitative study in GP practices in one Northern English city. Method In-depth, individual interviews were undertaken face-to-face or by telephone between December 2016 and May 2018, followed by thematic framework analysis. Results In this study 21 GPs, and 24 patients who did not attend or had cancelled their appointment were interviewed, deriving a range of potential explanations for non-attendance, including: system flaws; GP difficulties with booking appointments; patient difficulties with navigating the appointment system, particularly older patients and those from more deprived areas; patients leading ‘difficult lives’; and patients’ expectations of the referral, informed by their beliefs, circumstances, priorities, and the perceived prognosis. GPs recognised the importance of communication with the patient, particularly the need to tailor communication to perceived patient understanding and anxiety. GPs and practices varied in their responses to patient non-attendance, influenced by time pressures and perceptions of patient responsibility. Conclusion Failure to be seen within 2 weeks of urgent referral resulted from a number of patient and provider factors. The urgent referral process in general practice and cancer services should accommodate patient perceptions and responses, facilitate referral and attendance, and enable responses to patient non-attendance.
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164
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Jefferson L, Atkin K, Sheridan R, Oliver S, Macleod U, Hall G, Forbes S, Green T, Allgar V, Knapp P. Non-attendance at urgent referral appointments for suspected cancer: a qualitative study to gain understanding from patients and GPs. Br J Gen Pract 2019:bjgp1919X706625. [PMID: 31740457 DOI: 10.3399/bjgp1919x706625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/20/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The 2-week-wait urgent referral policy in the UK has sought to improve cancer outcomes by accelerating diagnosis and treatment. However, around 5-7% of symptomatic referred patients cancel or do not attend their hospital appointment. While subsequent cancer diagnosis was less likely in non-attenders, those with a diagnosis had worse early mortality outcomes. AIM To examine how interpersonal, communication, social, and organisational factors influence a patient's non-attendance. DESIGN AND SETTING Qualitative study in GP practices in one Northern English city. METHOD In-depth, individual interviews were undertaken face-to-face or by telephone between December 2016 and May 2018, followed by thematic framework analysis. RESULTS In this study 21 GPs, and 24 patients who did not attend or had cancelled their appointment were interviewed, deriving a range of potential explanations for non-attendance, including: system flaws; GP difficulties with booking appointments; patient difficulties with navigating the appointment system, particularly older patients and those from more deprived areas; patients leading 'difficult lives'; and patients' expectations of the referral, informed by their beliefs, circumstances, priorities, and the perceived prognosis. GPs recognised the importance of communication with the patient, particularly the need to tailor communication to perceived patient understanding and anxiety. GPs and practices varied in their responses to patient non-attendance, influenced by time pressures and perceptions of patient responsibility. CONCLUSION Failure to be seen within 2 weeks of urgent referral resulted from a number of patient and provider factors. The urgent referral process in general practice and cancer services should accommodate patient perceptions and responses, facilitate referral and attendance, and enable responses to patient non-attendance.
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Affiliation(s)
| | | | | | - Steven Oliver
- University of York, Hull York Medical School, Hull and York
| | - Una Macleod
- University of Hull, Hull York Medical School, Hull and York
| | - Geoff Hall
- University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds
| | | | - Trish Green
- University of Hull, Hull York Medical School, Hull and York
| | | | - Peter Knapp
- University of York, Hull York Medical School, Hull and York
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165
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Williams ED, Whitaker KL, Piano M, Marlow LA. Ethnic differences in barriers to symptomatic presentation in primary care: A survey of women in England. Psychooncology 2019; 28:2336-2343. [DOI: 10.1002/pon.5225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/19/2019] [Accepted: 09/09/2019] [Indexed: 12/11/2022]
Affiliation(s)
| | | | - Marianne Piano
- School of Health SciencesUniversity of Surrey Guildford UK
| | - Laura A.V. Marlow
- Department of Behavioural Science and HealthUniversity College London London UK
- School of Cancer and Pharmaceutical SciencesKing's College London, Guy's Hospital London SE1 9RT UK
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166
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Coutinho Medeiros G, Santos Thuler LC, Bergmann A. Factors influencing delay in symptomatic presentation of breast cancer in Brazilian women. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1525-1533. [PMID: 31381214 DOI: 10.1111/hsc.12823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/28/2019] [Accepted: 07/09/2019] [Indexed: 06/10/2023]
Abstract
The aim of this study was to evaluate delays in the presentation of symptomatic breast cancer in women (time interval between the perception of their first sign or symptom until the first medical appointment) and its risk factors. A cohort study composed of patients with breast cancer (symptomatic) admitted to an oncological centre in the city of Rio de Janeiro, Brazil was performed. The patients were interviewed during their first hospital visit. To assess time interval as a continuous variable, the median and interquartile ranges (IQR) were calculated. The outcome comprised delay in breast cancer presentation when time from the first sign or symptom perception to the first medical appointment was ≥90 days. A descriptive analysis was performed. The association between independent variables (epidemiological, social and demographic data, related to individual healthcare, clinical and current disease) and the outcome (delay in symptomatic presentation) was assessed by a univariate analysis applying odds ratios (OR). Associations with p < .20 in the univariate analysis were included in the multiple logistic regression model. Variables with a p < .05 were retained in the final model. A total of 388 women were included. The median time was of 41 days (interquartile range - IQR: 13.2-130.0); 34.3% delayed presentation at ≥ 90 days. After adjustment, the variables associated with a delay in presentation were frequency of gynaecological examination of over than 1 year (OR: 2.59, 95% CI: 1.67-4.05), no family history of breast cancer (OR: 1.96, 95% CI: 1.15-3.35), and income lower than the minimum wage (OR: 1.62, 95% CI: 1.03-2.55). A higher score in tangible support (OR: 0.98; 95% CI: 0.96-0.99) was associated with a lesser chance of delay in presentation. Thus, delay in presentation was associated with social barriers, access to health service, health information and individual factors.
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Affiliation(s)
| | - Luiz Claudio Santos Thuler
- Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
- Rio de Janeiro State Federal University (UNIRIO), Rio de Janeiro, Brazil
| | - Anke Bergmann
- Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
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167
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Zhou Y, van Melle M, Singh H, Hamilton W, Lyratzopoulos G, Walter FM. Quality of the diagnostic process in patients presenting with symptoms suggestive of bladder or kidney cancer: a systematic review. BMJ Open 2019; 9:e029143. [PMID: 31585970 PMCID: PMC6797416 DOI: 10.1136/bmjopen-2019-029143] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/27/2019] [Accepted: 07/24/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES In urological cancers, sex disparity exists for survival, with women doing worse than men. Suboptimal evaluation of presenting symptoms may contribute. DESIGN We performed a systematic review examining factors affecting the quality of the diagnostic process of patients presenting with symptoms of bladder or kidney cancer. DATA SOURCES We searched Medline, Embase and the Cochrane Library from 1 January 2000 to 13 June 2019. ELIGIBLE CRITERIA We focused on one of the six domains of quality of healthcare: timeliness, and examined the quality of the diagnostic process more broadly, by assessing whether guideline-concordant history, examination, tests and referrals were performed. Studies describing the factors that affect the timeliness or quality of the assessment of urinary tract infections, haematuria and lower urinary tract symptoms in the context of bladder or kidney cancer, were included. DATA EXTRACTION AND SYNTHESIS Data extraction and quality assessment were independently performed by two authors. Due to the heterogeneity of study design and outcomes, the results could not be pooled. A narrative synthesis was performed. RESULTS 28 studies met review criteria, representing 583 636 people from 9 high-income countries. Studies were based in primary care (n=8), specialty care (n=12), or both (n=8). Up to two-thirds of patients with haematuria received no further evaluation in the 6 months after their initial visit. Urinary tract infections, nephrolithiasis and benign prostatic conditions before cancer diagnosis were associated with diagnostic delay. Women were more likely to experience diagnostic delay than men. Patients who first saw a urologist were less likely to experience delayed evaluation and cancer diagnosis. CONCLUSIONS Women, and patients with non-cancerous urological diagnoses just prior to their cancer diagnosis, were more likely to experience lower quality diagnostic processes. Risk prediction tools, and improving guideline ambiguity, may improve outcomes and reduce sex disparity in survival for these cancers.
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Affiliation(s)
- Yin Zhou
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Marije van Melle
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Hardeep Singh
- Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | - Georgios Lyratzopoulos
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
| | - Fiona M Walter
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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168
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Dommett RM, Pring H, Cargill J, Beynon P, Cameron A, Cox R, Nechowska A, Wint A, Stevens MCG. Achieving a timely diagnosis for teenagers and young adults with cancer: the ACE "too young to get cancer?" study. BMC Cancer 2019; 19:616. [PMID: 31234813 PMCID: PMC6591830 DOI: 10.1186/s12885-019-5776-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 05/30/2019] [Indexed: 02/03/2023] Open
Abstract
Background Time to diagnosis (TTD) concerns teenagers and young adults (TYA) with cancer and may affect outcome. Methods Healthcare records from 105 TYA in a regional cancer service were assessed to document events from 1st symptom to treatment start. Detailed pathway construction was possible for 104 patients and allowed a multidisciplinary panel review of each pathway with assessment of good practice and lessons for the future. Results 1st presentation was to primary care in 86, and 93% consulted in primary care before diagnosis. Routes to Diagnosis were 45% via urgent 2 Week Wait pathways and 38% as emergency referrals. Total Interval (time from 1st presentation to treatment start) was median 63 (range 1–559) days, varying within/between diagnoses. Patient interval (time from 1st symptom to 1st presentation) was longest for lymphoma, carcinoma and bone tumour (medians: 9, 12, 20 days). Overall, time in primary care was short (median 3, range 0–537 days) compared to secondary care (median 29, range 0–195 days) and longest for lymphoma, carcinoma, brain/CNS (medians: 10, 15, 16 days). Specialist Care interval (time from 1st specialist visit to treatment start) was longest for bone, brain/CNS, lymphoma, carcinoma (medians: 30, 33, 36, 48 days). 40% pathways were rated as showing good/best practice but 16% were less than satisfactory. Continued safety-netting/support was identified from primary care but analysis suggested opportunities for improvement in transition through secondary care. Conclusions Previous reports of prolonged TTD have focused on delay in referral from primary care but this study suggests that this might be reduced by optimising management in secondary care.
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Affiliation(s)
- Rachel M Dommett
- South West TYA Cancer Service, Bristol Haematology Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Horfield Road, Bristol, BS2 8ED, UK.,Department of Paediatric Haematology Oncology & BMT, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Hannah Pring
- South West TYA Cancer Service, Bristol Haematology Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Horfield Road, Bristol, BS2 8ED, UK
| | - Jamie Cargill
- South West TYA Cancer Service, Bristol Haematology Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Horfield Road, Bristol, BS2 8ED, UK
| | - Paul Beynon
- South West TYA Cancer Service, Bristol Haematology Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Horfield Road, Bristol, BS2 8ED, UK
| | - Alison Cameron
- South West TYA Cancer Service, Bristol Haematology Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Horfield Road, Bristol, BS2 8ED, UK
| | - Rachel Cox
- Department of Paediatric Haematology Oncology & BMT, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Aoife Nechowska
- South West TYA Cancer Service, Bristol Haematology Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Horfield Road, Bristol, BS2 8ED, UK
| | - Alison Wint
- Macmillan GP and NHS Bristol, North Somerset & South Gloucestershire CCG, Bristol, UK
| | - Michael C G Stevens
- South West TYA Cancer Service, Bristol Haematology Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Horfield Road, Bristol, BS2 8ED, UK. .,Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
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Skrobanski H, Ream E, Poole K, Whitaker KL. Understanding primary care nurses' contribution to cancer early diagnosis: A systematic review. Eur J Oncol Nurs 2019; 41:149-164. [PMID: 31358248 DOI: 10.1016/j.ejon.2019.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 06/05/2019] [Accepted: 06/13/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Primary care nurses can contribute to cancer early diagnosis. The objective of this systematic review was to identify, appraise and synthesise evidence on primary care nurses' contribution towards cancer early diagnosis in developed countries. METHOD The following databases were searched in September 2017: MEDLINE, PsychINFO, CINAHL, SCOPUS, and EMBASE. Data were extracted on nurses': knowledge of cancer; frequency of 'cancer early diagnosis-related discussions' with patients; and perceived factors influencing these discussions. Studies were appraised using the Mixed Methods Appraisal Tool. RESULTS Twenty-one studies were included from: United States, United Kingdom, Ireland, Spain, Turkey, Australia, Brazil and Middle East. Studies were mostly of low quality (one did not meet any appraisal criteria, 15 met one, four met two, and one met three). Nurses' knowledge of cancer, and their frequency of 'cancer early diagnosis-related discussions', varied across countries. This may be due to measurement bias or nurses' divergent roles across healthcare systems. Commonly perceived barriers to having screening discussions included: lack of time, insufficient knowledge and communication skills, and believing that patients react negatively to this topic being raised. CONCLUSIONS Findings suggest a need for nurses to be adequately informed about, and have the confidence and skills to discuss, the topic of cancer early diagnosis. Further high-quality research is required to understand international variation in primary care nurses' contribution to this field, and to develop and evaluate optimal methods for preparing them for, and supporting them in, this.
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Affiliation(s)
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Karen Poole
- School of Health Sciences, University of Surrey, Guildford, UK
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170
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Vidal EA, Dubuc M, Bouati N, Bourrel G, Marchal F. [Understanding lower gynaecological cancer consultation delay and help-seeking behavior in patients over 65]. Bull Cancer 2019; 106:747-758. [PMID: 31182221 DOI: 10.1016/j.bulcan.2019.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/14/2019] [Accepted: 04/17/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Delays for consultation of more than six months exist for uterine cancer. Delays in diagnosis of more than five years exist for vulvar cancer. The peak incidence of these neoplasms appear after the age of 65 years. Patient's symptoms are characteristically swelling, vaginal bleeding or itching. This study aims to understand what is happening during this period for women over 65 years old. It also tries to identify triggers during the help-seeking period. METHODS Qualitative studies using semi-structured interviews with dual analyses (semio-pragmatic and psychodynamic) have been conducted on a population of older (65+) gynaecologic cancer patients, recruited from a French oncology centre. RESULTS Twelve patients were interviewed. Patients' courses of action were determined by the characteristics of their symptoms, their feelings and their emotions. Representations, subjective beliefs and past experiences were employed to make sense of their symptoms. The patient's friend and family circle had an important role in incentivizing the patient to seek consultation. Multiple factors affected the path towards consulting the doctor. The initial medical contact included several challenges. The patient would consult a doctor earlier if he had more information about his illness and if his relationship with the doctor was better. CONCLUSION Our findings are similar to those of other cancers. The peculiarity for this population appears to be the different representations of age-related changes in the reproductive system, and the taboo associated with this issue when facing friends and family.
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Affiliation(s)
- Ester Aragones Vidal
- Université Reims Champagne Ardenne, département de médecine générale, 51, rue Cognac-Jay, CS 30018, 51095 Reims cedex, France.
| | - Myriam Dubuc
- Institut de cancérologie de Lorraine, 6, avenue de Bourgogne, CS 30519, 54519 Vandœuvre-lès-Nancy cedex, France
| | - Noureddine Bouati
- CHU Grenoble Alpes, médecine gériatrique B, pavillon Elisée-Chatin, CS 10217, 38043 Grenoble cedex 9, France
| | - Gérard Bourrel
- Plateforme CEPS, laboratoire Epsilon EA4556, département de médecine générale, université de Montpellier, 2, rue École de Médecine, CS 59001, 34060 Montpellier cedex 2, France
| | - Fréderic Marchal
- Université de Lorraine, CNRS, institut de cancérologie de Lorraine, département de chirurgie, CRAN, UMR 7039, 6, avenue de Bourgogne, CS 30519, 54519 Vandœuvre-lès-Nancy cedex, France
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171
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Dapkevičiūtė A, Šapoka V, Martynova E, Pečeliūnas V. Time from Symptom Onset to Diagnosis and Treatment among Haematological Malignancies: Influencing Factors and Associated Negative Outcomes. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E238. [PMID: 31163661 PMCID: PMC6631661 DOI: 10.3390/medicina55060238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/17/2019] [Accepted: 05/30/2019] [Indexed: 11/17/2022]
Abstract
Background and objectives: Diagnostic delay causes unfavorable outcomes among cancer patients. It has been widely analyzed in solid tumors. However, data regarding hematological malignancies diagnostic delay are scarce. We aimed to evaluate diagnostic intervals, their influencing factors, and the negative effect on clinical outcomes among multiple myeloma and lymphoma patients. Materials and methods: One hundred patients diagnosed with multiple myeloma (n = 53) or lymphoma (n = 47) (ICD codes-C90, C81-C84) were asked to participate during their scheduled hematology consultations. Interval durations and the majority of influencing factors were assessed based on a face-to-face questionnaire. Data of disease characteristics were collected from medical records. Results: The median interval from symptom onset to registration for medical consultation was 30 (0-730) days, from registration to consultation 2 (0-30) days, from first consultation to diagnosis 73 (6-1779) days, and from diagnosis to treatment 5 (0-97) days. Overall time to diagnosis median was 151 (23-1800) days. Factors significantly prolonging diagnostic intervals in multivariate linear regression were living in big cities (p = 0.008), anxiety and depression (p = 0.002), self-medication (p = 0.019), and more specialists seen before diagnosis (p = 0.022). Longer diagnostic intervals resulted in higher incidences of multiple myeloma complications (p = 0.024) and more advanced Durie-Salmon stage (p = 0.049), but not ISS stage and Ann-Arbor staging systems for lymphomas. Conclusion: Median overall diagnostic delay was nearly 5 months, indicating that there is room for improvement. The most important factors causing delays were living in big cities, anxiety and depression, self-medication, and more specialists seen before diagnosis. Diagnostic delay may have a negative influence on clinical outcomes for multiple myeloma patients.
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Affiliation(s)
- Austėja Dapkevičiūtė
- Haematology, Oncology and Transfusion Medicine Centre, Vilnius University Hospital Santaros Klinikos, Santariškių 2, LT-08661 Vilnius, Lithuania.
- Institute of Clinical Medicine, Vilnius University, Santariškių 2, LT-08661 Vilnius, Lithuania.
| | - Virginijus Šapoka
- Institute of Clinical Medicine, Vilnius University, Santariškių 2, LT-08661 Vilnius, Lithuania.
| | - Elena Martynova
- Quantitative Psychology Program, University of Virginia, 485 McCormick Road Charlottesville, VA 22903, USA.
| | - Valdas Pečeliūnas
- Haematology, Oncology and Transfusion Medicine Centre, Vilnius University Hospital Santaros Klinikos, Santariškių 2, LT-08661 Vilnius, Lithuania.
- Institute of Clinical Medicine, Vilnius University, Santariškių 2, LT-08661 Vilnius, Lithuania.
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Mou J, Bolieu EL, Pflugeisen BM, Amoroso PJ, Devine B, Baldwin LM, Frank LL, Johnson RH. Delay in Treatment After Cancer Diagnosis in Adolescents and Young Adults: Does Facility Transfer Matter? J Adolesc Young Adult Oncol 2019; 8:243-253. [PMID: 30785806 PMCID: PMC6909758 DOI: 10.1089/jayao.2018.0128] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Timeliness is one of the fundamental yet understudied quality metrics of cancer care. Little is known about cancer treatment delay among adolescent and young adult (AYA) cancer patients. This study assessed cancer treatment delay, with a specific focus on facility transfer and diagnosis/treatment interval. Methods: Based on MultiCare Health System's (MHS's) institutional cancer registry data of AYA patients diagnosed during 2006-2015, this study analyzed patient demographics, insurance, clinical characteristics, and time of diagnosis and treatment initiation. Chi-squared tests, cumulative hazard estimates, and Cox proportional regression were used for univariable analysis. Multivariate regression models were used to test the association between care transfer and days of interval or prolonged delay, controlling for baseline parameters. Results: Of 840 analytic AYA cases identified, 457 (54.5%) were both diagnosed and treated within MHS. A total of 45.5% were either diagnosed or treated elsewhere. Mean and median intervals for treatment initiation were 27.03 (95% CI = 21.94-33.14) and 8.00 days (95% CI = 5.00-11.00), respectively, with significant differences between patients with and without facility transfer. Transfer was significantly correlated with longer length of diagnosis-to-treatment interval. Treatment delay, ≥1 week, was associated with transfer, female sex, older age, no surgery involvement, and more treatment modalities. Treatment delay, ≥4 weeks, was associated with transfer, female sex, no insurance, and no surgery involvement. Conclusion: In a community care setting, the diagnosis-to-treatment interval is significantly longer for transferred AYA cancer patients than for patients without a transfer. Future studies are warranted to explore the prognostic implications and the reasons for delays within specific cancer types.
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Affiliation(s)
- Jin Mou
- MultiCare Institute for Research & Innovation, Tacoma, Washington
| | | | | | - Paul J. Amoroso
- MultiCare Institute for Research & Innovation, Tacoma, Washington
| | - Beth Devine
- Department of Health Services, University of Washington, Seattle, Washington
| | - Laura-Mae Baldwin
- Department of Family Medicine, Community Engagement, Institute of Translational Health Sciences, University of Washington, Seattle, Washington
| | - Laura L. Frank
- MultiCare Institute for Research & Innovation, Tacoma, Washington
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Primary health care factors associated with late presentation of cancer in Saudi Arabia. JOURNAL OF RADIOTHERAPY IN PRACTICE 2019. [DOI: 10.1017/s1460396919000232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIntroduction:Delays in the diagnosis of cancer were found to be a worldwide matter, and the early cancer detection has been targeted as a way to improve survival. Quantitative studies from Saudi Arabia reported a high number of cancer cases presenting at cancer centres for the first time with more advanced stages of the disease progression compared to Western countries without exploring the reasons for this phenomenon. Worldwide research identified several factors that contribute to delay in the diagnosis and treatment of cancer which were attributed to both patient and healthcare system. However, it was argued that variation in the operation of health systems and the socio-cultural context across countries makes it difficult to generalise findings beyond individuals’ countries. This necessitates country specific research to investigate why patients in Saudi Arabia present to cancer centres with late/advanced stages of their diseases.Research aim and objectives:The aim of this study is to identify and explore the factors that contribute to late-stage presentation of common cancers in Saudi Arabia. The main objective of this study is to understand the help seeking journey taken by patients with cancer from the time they discovered or felt their symptoms until the time they have their treatment initiated.Methods:Qualitative interviewing was used to collect data from 20 patients and 15 health professionals. The interviews were transcribed and then were subjected to the thematic analysis using a framework approach developed by Ritchie and Spencer (1994).Results:While some findings support what previous studies found as contributing factors responsible for delayed presentation of common cancers, this study identified several factors, which are believed to be country-specific. The ‘role of General Practitioner (GP)’, ‘challenges facing GPs’ and ‘ambiguity of the referral system’ were found to be factors that contribute to delay in the diagnosis and treatment of cancer in Saudi Arabia.Conclusion:This research identified several factors that need to be investigated in the future using quantitative methods. There is a need to investigate the extent of using alternative medicine and its possible association with late presentation of cancer.
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174
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Hameed Khaliq I, Mahmood HZ, Sarfraz MD, Masood Gondal K, Zaman S. Pathways to care for patients in Pakistan experiencing signs or symptoms of breast cancer. Breast 2019; 46:40-47. [PMID: 31075671 DOI: 10.1016/j.breast.2019.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 04/15/2019] [Accepted: 04/22/2019] [Indexed: 12/17/2022] Open
Abstract
Multiple social and financial barriers exist to breast cancer detection in Pakistan, which may cause a delay in seeking care and the final diagnosis. This analytical study documents the pathways and time courses associated with referral to diagnostic centres to evaluate the clinical signs and symptoms of breast cancer. This report also verifies the association between socio-demographic and clinical indicators concerning the length of time spent before reaching diagnostic facilities. A purposive sample of 200 patients was selected from two tertiary care hospitals in Lahore, Pakistan, for the interviews. Descriptive statistics (that is, percentages, frequencies, and measures of central tendencies) and a multiple linear regression model were used to achieve the study objectives. The descriptive model showed 31-128 days interval between a patient's awareness of a clinical sign or symptom and receiving care. The healthcare system, including traditional healers, took from 7 to 194 days, and the time to diagnosis ranged from 15 to 30 days. Pain severity, larger tumour size, lack of clinical improvement, and the desire to obtain better treatment were reasons given for seeking care, but lack of awareness and fear of financial burden related to accessing healthcare facilities were identified as barriers. Moreover, socio-demographic and other predictive clinical factors were potentially associated with and substantially influenced the likelihood of the increased length of breast cancer patients' time to reach diagnostic centres. In conclusion, referrals by multiple healthcare providers, especially traditional healers and general practitioners, was a significant predictor for delay in diagnosis. Therefore, increased awareness and a responsive healthcare system may reduce the time from the recognition of symptoms to the early detection of breast cancer among women, thus improving outcomes in a developing country.
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Affiliation(s)
- Imran Hameed Khaliq
- Department of Public Health, University of Health Sciences Lahore, Pakistan.
| | - Hafiz Zahid Mahmood
- Department of Economics, COMSATS University Islamabad, Lahore Campus, Pakistan
| | | | - Khalid Masood Gondal
- Vice Chancellor, King Edward Medical University/ Mayo Hospital, Lahore, Pakistan
| | - Shakila Zaman
- Department of Public Health, University of Health Sciences Lahore, Pakistan
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175
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Antel K, Levetan C, Mohamed Z, Louw VJ, Oosthuizen J, Maartens G, Verburgh E. The determinants and impact of diagnostic delay in lymphoma in a TB and HIV endemic setting. BMC Cancer 2019; 19:384. [PMID: 31023278 PMCID: PMC6485177 DOI: 10.1186/s12885-019-5586-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 04/05/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Little is known about the pathway to diagnosis of lymphoma in Sub-Saharan Africa, despite the increased risk of lymphoma in people living with HIV (PLHIV). The challenges of diagnosis in this setting include diagnostic confusion with extrapulmonary tuberculosis (EPTB), which commonly causes lymphadenopathy in PLHIV. METHODS We analysed the time to diagnosis and treatment in patients using predetermined time intervals. Univariate and multivariable analyses were performed to determine the relationship between patient and disease-specific variables with delays to diagnosis. We were particularly interested in the impact of HIV, empiric tuberculosis therapy and fine-needle aspirate for cytology (FNAC) in contributing to delay. RESULTS Patients (n = 163), 29% HIV-infected, waited a median of 4 weeks before seeking medical attention. It took a median of 7 weeks for the diagnosis of lymphoma to be made from the time the patient sought medical attention, termed the healthcare practitioner interval. In multivariable logistic regression analysis, diagnostic delay > 6 weeks was associated with late-stage disease (OR 2.3, 95% CI 1.1-5.2) and Hodgkin lymphoma (HL) (OR 3.0, 95% CI 1.1-8.0). HIV status was not associated with diagnostic delay (OR 0.9, 95% CI 0.3-2.2). The median time to diagnosis was a median of 4 weeks longer for patients on tuberculous (TB) therapy (n = 16, p = 0.28) and patients who underwent an FNAC (n = 63, p = 0.04). Where FNAC was performed, it was diagnostic for lymphoma in only 11%. Diagnostic delay was not associated with overall survival. CONCLUSIONS Time-to-diagnosis of lymphoma in South Africa was similar to that reported from high-income countries and shows significant periods of delay between the onset of symptoms to diagnosis and treatment. The longest period of delay was in the health practitioner interval. Education regarding the significance of lymphadenopathy for both patients and health care practitioners and appropriate investigative steps preferably by best-practice algorithms specific to TB-endemic areas are needed to shorten the time-to-diagnosis of lymphoma.
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Affiliation(s)
- Katherine Antel
- Division of Haematology, Department of Internal Medicine, University of Cape Town, Cape Town, South Africa.
| | - Carly Levetan
- Medical advisor, Cell and Gene Therapy, Novartis Oncology, Sydney, Australia
| | - Zainab Mohamed
- Department of Oncology, University of Cape Town, Cape Town, South Africa
| | - Vernon J Louw
- Division of Haematology, Department of Internal Medicine, University of Cape Town, Cape Town, South Africa
| | - Jenna Oosthuizen
- Division of Haematology, Department of Internal Medicine, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Division of Pharmacology, Department of Internal Medicine, University of Cape Town, Cape Town, South Africa
| | - Estelle Verburgh
- Division of Haematology, Department of Internal Medicine, University of Cape Town, Cape Town, South Africa
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Moghaddam ES, Shahnazi H, Hassanzadeh A. Predictive Power of PEN-3 Model Constructs in Breast Cancer Screening Behaviors among Teachers: A Cross- Sectional Study in Central Iran. Eur J Breast Health 2019; 15:105-110. [PMID: 31001612 DOI: 10.5152/ejbh.2019.4417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 01/28/2019] [Indexed: 11/22/2022]
Abstract
Objective Identifying the factors influencing screening is necessary to promote early detection of breast cancer. This study aims to determine the predictive power of PEN-3 model structures in breast cancer screening behaviors among teachers of Isfahan city in Iran. Materials and Methods This cross-sectional study was conducted on 192 female teachers in Isfahan selected by the multi-stage random sampling method. A questionnaire based on PEN-3 model was used for data collection. Statistical analysis was conducted using SPSS version 20 (multiple linear regression analysis, independent t-test, Pearson correlation coefficient), and p<0.05 was considered statistically significant. Results The mean score of behavior, perceptual, enabling and nurturer factors in early detection of breast cancer was 36.5±30.5, 74.6±8.9, 65.5±19.9 and 68.1±20.7, respectively. The mean score of behavior in early detection of breast cancer in women with individual and familial history of breast disease was significantly higher than that of those who did not have such history. Perceptual and nurturer factors as the best predictors of screening behaviors were associated with screening behaviors. Conclusion The study results indicate that nurturer and perceptual factors were the best predictors of breast cancer screening behaviors among teachers. Therefore, attention to these constructs in developing educational interventions is highly recommended.
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Affiliation(s)
| | - Hossein Shahnazi
- Department of Health Education and Health Promotion, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Akbar Hassanzadeh
- Department of Epidemiology and Biostatistics, Isfahan University of Medical Sciences, Isfahan, Iran
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Allgar VL, Oliver SE, Chen H, Oviasu O, Johnson MJ, Macleod U. Time intervals from first symptom to diagnosis for head and neck cancers: An analysis of linked patient reports and medical records from the UK. Cancer Epidemiol 2019; 59:37-45. [DOI: 10.1016/j.canep.2019.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
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Scott SE, Penfold C, Saji S, Curtis S, Watts C, Hamilton W, Joannides AJ, Walter FM. 'It was nothing that you would think was anything': Qualitative analysis of appraisal and help seeking preceding brain cancer diagnosis. PLoS One 2019; 14:e0213599. [PMID: 30901334 PMCID: PMC6430370 DOI: 10.1371/journal.pone.0213599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/25/2019] [Indexed: 12/29/2022] Open
Abstract
Background The patient’s interpretation of the events and decisions leading up to consultation with a healthcare professional for symptoms of brain cancer is under researched. The aim of this study was to document responses to noticing the changes preceding a diagnosis of brain cancer and living with them, focusing on appraisal of changes and the decision to seek (and re-seek) help, with attention to the psychological processes underpinning the appraisal and help-seeking intervals. Method In this qualitative study set in Eastern and NW England, in-depth interviews with adult patients recently diagnosed with primary brain cancer and their family members were analysed thematically, using the Model of Pathways to Treatment as a conceptual framework. Results 39 adult patients were interviewed. Regarding the appraisal interval, cognitive heuristics were found to underpin explanations of changes/symptoms. The subtlety and normality of changes often suggested nothing serious was wrong. Common explanations included stress or being busy at work, or age and these did not seem to warrant a visit to a doctor. Explanations and the decision to seek help were made within the social context, with friends, family and work colleagues contributing to appraisal and help-seeking decisions. Regarding the help-seeking interval, barriers to seeking help reflected components of Social Cognitive Theory, and included having other priorities, outcome expectations (e.g. ‘feeling silly’, not sure much can be done about it, not wanting to waste doctors’ time) and accessibility of a preferred healthcare professional. Conclusion Application of psychological theory facilitated understanding of the influences on cognition and behaviour. The study highlights implications for theory, awareness campaigns and potential opportunities promoting more timely help-seeking.
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Affiliation(s)
- Suzanne E. Scott
- Centre for Oral, Clinical & Translational Science, Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College London, Guy’s Hospital, London, United Kingdom
- * E-mail:
| | - Clarissa Penfold
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Smiji Saji
- Clinical School, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Sarah Curtis
- Centre for Oral, Clinical & Translational Science, Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Colin Watts
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Willie Hamilton
- Willie Hamilton, St Luke’s Campus, University of Exeter, Exeter, United Kingdom
| | - Alexis J. Joannides
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Fiona M. Walter
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
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179
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Kummer S, Walter FM, Chilcot J, Emery J, Sutton S, Scott SE. Do cognitive heuristics underpin symptom appraisal for symptoms of cancer?: A secondary qualitative analysis across seven cancers. Psychooncology 2019; 28:1041-1047. [PMID: 30828881 DOI: 10.1002/pon.5049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To explore the evidence for cognitive heuristics or "rules of thumb" used within patients' reports of symptom appraisal and decisions to seek help for symptoms of cancer. METHODS A secondary analysis of interviews from existing studies that explored symptom appraisal in patients who had sought help for potential symptoms of cancer. Transcripts from n = 50 in-depth interviews with patients referred with symptoms suspicious of cancer (pancreas, colorectal, oral, lung, melanoma, breast, and prostate) were re-analysed using a deductive thematic approach underpinned by the heuristics outlined in the Common Sense Model of Illness Self-regulation as set within the Model of Pathways to Treatment. RESULTS The most dominant heuristic in patient reports was the Rate of change rule (ie, symptoms that are worsening, increasing, or have a sudden onset [rather than improving, stable or decreasing in number] are more likely to indicate illness). There was also support for the Duration rule, Pattern rule, Chronology rule, Severity (of interference) rule, Age-illness rule, Novelty rule, Similarity rule, Location rule, and Optimistic bias rule. There was a lack of evidence for the Prevalence and Stress-illness rules. CONCLUSIONS People do appear to use heuristics to guide their appraisal of symptoms and their perceived need for healthcare. Heuristics may be an important aspect underlying symptom misinterpretation, thus making them key targets for interventions. For instance, campaigns could tackle cognitive biases rather than focusing on specific symptom awareness. Myth-busting messages could highlight that intermittent, mild symptoms, and symptoms that are not worsening can be signs of a serious health problem.
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Affiliation(s)
- Sonja Kummer
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge.,Centre for Cancer Research, Department of General Practice, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne
| | - Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London
| | - Jon Emery
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge.,Centre for Cancer Research, Department of General Practice, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne
| | - Stephen Sutton
- Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge
| | - Suzanne E Scott
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London
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180
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Moriarty Y, Townson J, Quinn-Scoggins H, Padgett L, Owen S, Smits S, Playle R, Dimitropoulou P, Sewell B, Kolovou V, Buckle P, Carter B, Edwards A, Hepburn J, Matthews M, Mitchell C, Neal RD, Robling M, Wood F, Brain K. Improving cancer symptom awareness and help-seeking among adults living in socioeconomically deprived communities in the UK using a facilitated health check: A protocol for the Awareness and Beliefs About Cancer (ABACus) Randomised Control Trial. BMC Public Health 2019; 19:285. [PMID: 30866887 PMCID: PMC6417119 DOI: 10.1186/s12889-019-6612-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/28/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cancer survival is lower in socioeconomically deprived communities, partly due to low awareness of symptoms, negative beliefs and delayed help-seeking. We developed an interactive health check questionnaire facilitated by trained lay advisors. It entails 29 questions about background, lifestyle and health with tailored behaviour change advice. Personalised results are printed using a traffic light (red/amber/green) system, highlighting areas where action should be taken. This is an individually randomised control trial to test effectiveness of the health check on symptom recognition. METHODS A total 246 participants aged 40+ years will be recruited from community and healthcare settings in socioeconomically deprived areas of Yorkshire and South Wales. Participants will be randomised to receive the health check or standard care (1:1 ratio). Outcome measures include: adapted Awareness and Beliefs about Cancer (primary outcome), brief State Trait Anxiety Inventory, intentions and motivation to adopt recommended health behaviours (early symptom presentation, cancer screening and lifestyle behaviours), adapted Client Service Receipt Inventory, brief medical history/screening and demographic questionnaire at: baseline; 2-weeks; and 6-months post-randomisation. A purposive sample of intervention sessions will be audio-recorded (n = 24) and half will additionally be observed (n = 12). Semi-structured interviews will take place at 2-weeks (n = 30) and 6-months (n = 15-20) post-randomisation. The primary analysis will compare cancer symptom recognition scores between arms at 2-weeks. Secondary analysis will assess cancer beliefs, barriers/time to presentation, screening and lifestyle behaviours, anxiety and costs. A process evaluation will assess intervention fidelity, dose and contamination. The London-Surrey NHS Research Ethics Committee (Ref: 17/LO/1507) approved this trial. DISCUSSION This is a trial of a theoretically underpinned complex intervention which has undergone phase 1 and 2 development work. The findings will evaluate evidence about the effect of the health check on symptom awareness. Although there are few exclusion criteria there are limitations regarding the population we are able to reach, who may have even higher risks of late diagnosis and poor cancer prognosis. However, the health check has the potential to improve cancer symptom awareness and encourage early help-seeking behaviour in deprived populations, thereby reducing inequalities in longer term cancer outcomes. TRIAL REGISTRATION Retrospectively registered with ISRCTN (Ref: ISRCTN16872545 ) on 12.01.2018.
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Affiliation(s)
- Yvonne Moriarty
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Julia Townson
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Harriet Quinn-Scoggins
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Louise Padgett
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT UK
| | - Sioned Owen
- Tenovus Cancer Care, Gleider House, Ty-Glas Rd, Cardiff, CF14 5BD UK
| | - Stephanie Smits
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Rebecca Playle
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Polyxeni Dimitropoulou
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Bernadette Sewell
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP UK
| | - Vasiliki Kolovou
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Peter Buckle
- Marie Curie Research Voices, Marie Curie, 89 Albert Embankment, London, SE1 7TP UK
| | - Ben Carter
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Julie Hepburn
- Public Involvement Community, Health and Care Research Wales support Centre, Castlebridge 4, 15-19, Cowbridge Road East, Cardiff, CF11 9AB UK
| | - Maura Matthews
- Tenovus Cancer Care, Gleider House, Ty-Glas Rd, Cardiff, CF14 5BD UK
| | - Caroline Mitchell
- Academic Unit of Primary Medical Care, University of Sheffield, Northern General Hospital, Sheffield, S5 7AU UK
| | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL UK
| | - Michael Robling
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Fiona Wood
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
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Missed opportunities for diagnosing brain tumours in primary care: a qualitative study of patient experiences. Br J Gen Pract 2019; 69:e224-e235. [PMID: 30858332 PMCID: PMC6428480 DOI: 10.3399/bjgp19x701861] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 11/26/2018] [Indexed: 12/11/2022] Open
Abstract
Background Brain tumours are uncommon, and have extremely poor outcomes. Patients and GPs may find it difficult to recognise early symptoms because they are often non-specific and more likely due to other conditions. Aim To explore patients’ experiences of symptom appraisal, help seeking, and routes to diagnosis. Design and setting Qualitative study set in the East and North West of England. Method In-depth interviews with adult patients recently diagnosed with a primary brain tumour and their family members were analysed thematically, using the Model of Pathways to Treatment as a conceptual framework. Results Interviews were carried out with 39 patients. Few participants (n = 7; 18%) presented as an emergency without having had a previous GP consultation; most had had one (n = 15; 38%), two (n = 9; 23%), or more (n = 8; 21%) GP consultations. Participants experienced multiple subtle ‘changes’ rather than ‘symptoms’, often noticed by others rather than the patient, which frequently led to loss of interest or less ability to engage with daily living activities. The most common changes were in cognition (speaking, writing, comprehension, memory, concentration, and multitasking), sleep, and other ‘head feelings’ such as dizziness. Not all patients experienced a seizure, and few seizures were experienced ‘out of the blue’. Quality of communication in GP consultations played a key role in patients’ subsequent symptom appraisal and the timing of their decision to re-consult. Conclusion Multiple subtle changes and frequent GP visits often precede brain tumour diagnosis, giving possible diagnostic opportunities for GPs. Refined community symptom awareness and GP guidance could enable more direct pathways to diagnosis, and potentially improve patient experiences and outcomes.
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182
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Janse van Rensburg B, Freeman CR, Ford PJ, Taing MW. Investigating the management of potentially cancerous nonhealing mouth ulcers in Australian community pharmacies. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:415-423. [PMID: 30246463 DOI: 10.1111/hsc.12661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 05/20/2023]
Abstract
We sought to examine the management and referral of nonhealing mouth ulcer presentations in Australian community pharmacies in the Greater Brisbane region. Trained simulated patients visited 220 randomly selected community pharmacies within the Greater Brisbane region in 2016. Simulated patients enacted two nonhealing (>1 month) mouth ulcer scenarios: A direct product request (DPR) (n = 110) and a symptom-based request (SBR) (n = 110). Results were documented and evaluated against Australian national pharmacy practice standards. Referral rates for pharmacy staff (pharmacist, pharmacy assistant or mixed-pharmacist and assistant) were also assessed. Australian pharmacy practice standards recommend staff ask six key questions during SBR and DPR consultations to enable informed decision-making. Two questions relating to identifying the patient and their symptoms were asked in the majority of interactions (76% and 69% respectively); the remaining four questions relating to symptom duration, treatments tried, other medications, and medical conditions were enquired in only 32%, 53%, 31%, and 27% of interactions, respectively. Simulated patients were referred to the doctor/dentist in only 11.8% of all interactions (both scenarios requiring referral). Overall, staff handling of nonhealing mouth ulcer consultations was suboptimal compared to national professional standards. In particular, duration of the nonhealing mouth ulcer was enquired in less than one-third of consultations potentially resulting in low referral rates by staff. This study identifies the need for increased oral cancer awareness and education for community pharmacy staff and reinforcing the importance of practising according to professional standards to effectively screen for potentially cancerous nonhealing mouth lesions.
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Affiliation(s)
| | | | - Pauline J Ford
- School of Dentistry, The University of Queensland, QLD, Australia
| | - Meng-Wong Taing
- School of Pharmacy, The University of Queensland, QLD, Australia
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183
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Marcu A, Muller C, Ream E, Whitaker KL. Online Information-Seeking About Potential Breast Cancer Symptoms: Capturing Online Behavior With an Internet Browsing Tracking Tool. J Med Internet Res 2019; 21:e12400. [PMID: 30724741 PMCID: PMC6381403 DOI: 10.2196/12400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/05/2018] [Accepted: 12/09/2018] [Indexed: 01/18/2023] Open
Abstract
Background People engage in health information-seeking online when experiencing unusual or unfamiliar bodily changes. It is not well understood how people consult the internet for health information after the onset of unfamiliar symptoms and before receiving a potential diagnosis and how online information-seeking can help people appraise their symptoms. This lack of evidence may be partly due to methodological limitations in capturing in real time the online information-seeking process. Objective We explored women’s symptom attribution and online health information-seeking in response to a hypothetical and unfamiliar breast change suggestive of cancer (nipple rash). We also aimed to establish the feasibility of capturing in real time the online information-seeking process with a tool designed to track participant online searches and visited websites, the Vizzata browser tracker. Methods An online survey was completed by 56 cancer-free women (mean age 60.34 [SD 7.73] years) responding to a scenario asking them to imagine noticing a red scaly rash on the nipple. Participants were asked to make symptom attributions when presented with the scenario (T1) and again after seeking information online (T2). The online tracking tool, embedded in the survey, was used to capture in real time participant search terms and accessed websites. Results The tracking tool captured the search terms and accessed websites of most of the participants (46/56, 82%). For the rest (10/56, 18%), there was evidence of engagement in online information-seeking (eg, medical terminology and cancer attribution at T2) despite their searching activity not being recorded. A total of 25 participants considered cancer as a potential cause for the nipple rash at T1, yet only one of these used cancer as a search term. Most participants (40/46, 87%) used rash-related search terms, particularly nipple rash and rash on nipple. The majority (41/46, 89%) accessed websites containing breast cancer information, with the National Health Service webpage “Paget disease of the nipple” being the most visited one. At T2, after engaging in the internet search task, more participants attributed the nipple rash to breast cancer than at T1 (37/46, 66% vs 25/46, 45%), although a small number of participants (6/46) changed from making a cancer attribution at T1 to a noncancer one at T2. Conclusions Making a cancer attribution for an unfamiliar breast change did not necessarily translate into cancer-termed searches. Equally, not all internet searches led to a cancer attribution. The findings suggest that online information-seeking may not necessarily help women who experience unfamiliar breast cancer symptoms understand their condition. Despite some technical issues, this study showed that it is feasible to use an online browser tracking tool to capture in real time information-seeking about unfamiliar symptoms.
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Affiliation(s)
- Afrodita Marcu
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Cecile Muller
- School of Psychology, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Emma Ream
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Katriina L Whitaker
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
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184
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Howell DA, Hart RI, Smith AG, Macleod U, Patmore R, Roman E. Disease-related factors affecting timely lymphoma diagnosis: a qualitative study exploring patient experiences. Br J Gen Pract 2019; 69:e134-e145. [PMID: 30692091 PMCID: PMC6355261 DOI: 10.3399/bjgp19x701009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/24/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Expediting cancer diagnosis is widely perceived as one way to improve patient outcomes. Evidence indicates that lymphoma diagnosis is often delayed, yet understanding of issues influencing this is incomplete. AIM To explore patients' and their relatives' perceptions of disease-related factors affecting time to diagnosis of Hodgkin and non-Hodgkin lymphoma. DESIGN AND SETTING Qualitative UK study involving patients with indolent and aggressive lymphomas, and their relatives, from an established population-based cohort in the north of England. METHOD Semi-structured interviews with 35 patients and 15 of their relatives. Interviews were audiorecorded and transcribed, and qualitative descriptive analysis was undertaken. RESULTS Participant accounts suggest that certain features of lymphoma can impact on patients' and healthcare providers' (HCPs) responses to disease onset. Three characteristics stand out: disease occurrence (rare), manifestation (varied), and investigative options (often inconclusive). Interviewees described how they, and some HCPs, lacked familiarity with lymphoma, seldom considering it a likely explanation for their symptoms. Symptoms reported were highly variable, frequently non-specific, and often initially thought to be associated with various benign, self-limiting causes. Blood tests and other investigations, while frequently able to detect abnormalities, did not reliably indicate malignancy. Interviewees reported the potential for improvements among HCPs in information gathering, communication of uncertainty, and re-presentation advice for non-resolving/progressive health changes. CONCLUSION This study demonstrates the complex characteristics of lymphoma, perceived by patients as prolonging time to diagnosis, often despite significant effort by themselves, their relatives, and HCPs to expedite this process. The findings also illustrate why simple solutions to delayed diagnosis of lymphoma are lacking.
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Affiliation(s)
- Debra A Howell
- Epidemiology and Cancer Statistics Group, professor of epidemiology, Department of Health Sciences, University of York, York
| | - Ruth I Hart
- Epidemiology and Cancer Statistics Group, professor of epidemiology, Department of Health Sciences, University of York, York
| | - Alexandra G Smith
- Epidemiology and Cancer Statistics Group, professor of epidemiology, Department of Health Sciences, University of York, York
| | - Una Macleod
- Hull York Medical School, University of Hull, Hull
| | - Russell Patmore
- Department of Haematology, Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Hull
| | - Eve Roman
- Epidemiology and Cancer Statistics Group, professor of epidemiology, Department of Health Sciences, University of York, York
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185
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Low DH, Phipps W, Orem J, Casper C, Bender Ignacio RA. Engagement in HIV Care and Access to Cancer Treatment Among Patients With HIV-Associated Malignancies in Uganda. J Glob Oncol 2019; 5:1-8. [PMID: 30763144 PMCID: PMC6426497 DOI: 10.1200/jgo.18.00187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Health system constraints limit access to HIV and cancer treatment programs in sub-Saharan Africa. Limited access and continuity of care affect morbidity and mortality of patients with cancer and HIV. We assessed barriers in the care cascade of comorbid HIV and cancer. PATIENTS AND METHODS Structured interviews were conducted with 100 adult patients with HIV infection and new diagnoses of cancer at the Uganda Cancer Institute. Participants completed follow-up questionnaires after 1 year to assess ongoing engagement with and barriers to care. RESULTS The median time from new-onset cancer symptoms to initiation of cancer care at the Uganda Cancer Institute was 209 days (interquartile range, 113 to 384 days). Persons previously established in HIV care waited less overall to initiate cancer care ( P = .04). Patients established in HIV care experienced shorter times from initial symptoms to seeking of cancer care ( P = .02) and from seeking of care to cancer diagnosis ( P = .048). Barriers to receiving care for HIV and cancer included difficulty traveling to multiple clinics/hospitals (46%), conflicts between HIV and cancer appointments (23%), prohibitive costs (21%), and difficulty adhering to medications (15%). Reporting of any barriers to care was associated with premature discontinuation of cancer treatment ( P = .003). CONCLUSION Patients with HIV-associated malignancies reported multiple barriers to receiving care for both conditions, although knowledge of HIV status and engagement in HIV care before presentation with malignancy reduced subsequent time to the start of cancer treatment. This study provides evidence to support creation and evaluation of integrated HIV and cancer care models.
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Affiliation(s)
- Daniel H. Low
- Swedish Family Medicine Residency at Cherry Hill, Seattle, WA
- University of Washington School of Medicine, Seattle, WA
| | - Warren Phipps
- University of Washington School of Medicine, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jackson Orem
- Fred Hutchinson Cancer Research Center, Seattle, WA
- Uganda Cancer Institute, Kampala, Uganda
| | - Corey Casper
- Fred Hutchinson Cancer Research Center, Seattle, WA
- Infectious Diseases Research Institute, Seattle, WA
| | - Rachel A Bender Ignacio
- University of Washington School of Medicine, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
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186
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Mueller J, Davies A, Jay C, Harper S, Blackhall F, Summers Y, Harle A, Todd C. Developing and testing a web-based intervention to encourage early help-seeking in people with symptoms associated with lung cancer. Br J Health Psychol 2019; 24:31-65. [PMID: 29999214 PMCID: PMC6492236 DOI: 10.1111/bjhp.12325] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/05/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To detail the development method used to produce an online, tailored, theory-based, user-centred intervention to encourage help-seeking for potential lung cancer symptoms. DESIGN Intervention development was structured around the person-based approach. The feasibility study involved a randomized controlled trial design. METHODS Intervention development drew on qualitative inquiries, the Theory of Planned Behaviour (TPB), and identifying concrete mechanisms of change to implement in the intervention (Behaviour Change Techniques). The final intervention involved two key features: (1) tailoring and (2) 'TPB components' to target beliefs about help-seeking. In an online feasibility study, we recruited people reporting potential lung cancer symptoms using mailing lists, social media, websites, and Google AdWords. Participants were randomized to the intervention, a tailored comparison group (CG) without TPB-components, an untailored CG with TPB components, or a CG with neither. Following treatment, participants clicked a button to indicate whether they wished to make an appointment and completed a TPB questionnaire. RESULTS A total of 130 participants reporting relevant symptoms were recruited (24% of website visitors). Participants in the intervention group reported higher intention to seek help than those who received tailored information without TPB components (p = .03). User comments indicate more support is needed for people who sought help for symptoms, but felt dismissed. CONCLUSIONS The potential for differential dropout in online randomized trials requires careful consideration. Future help-seeking interventions should provide support for those who have previously felt dismissed by health professionals. The feasibility study provides some evidence that our 'TPB components' were effective, but validation in a powered trial is necessary. Statement of contribution What is already known on this subject? People with lung cancer often delay presenting symptoms to health services. Some patients (or their family/friends) look up symptoms online before their diagnosis, to decide whether they should see a doctor. Interventions are needed to ensure people can find useful information online that will encourage them to seek help for relevant symptoms. What does this study add? Theory-mapping and user involvement facilitated systematic intervention development. Lung cancer help-seeking interventions should address salient beliefs and personal relevance. The potential for differential dropout in online randomized trials requires careful consideration.
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Affiliation(s)
- Julia Mueller
- School of Health SciencesUniversity of ManchesterUK
- Manchester Academic Health Science CentreUK
- School of Computer ScienceUniversity of ManchesterUK
| | - Alan Davies
- School of Computer ScienceUniversity of ManchesterUK
| | - Caroline Jay
- School of Computer ScienceUniversity of ManchesterUK
| | - Simon Harper
- School of Computer ScienceUniversity of ManchesterUK
| | - Fiona Blackhall
- Manchester Academic Health Science CentreUK
- Department of Medical OncologyThe Christie NHS Foundation TrustManchesterUK
- Division of Molecular and Clinical Cancer SciencesUniversity of ManchesterUK
| | - Yvonne Summers
- Manchester Academic Health Science CentreUK
- Department of Medical OncologyThe Christie NHS Foundation TrustManchesterUK
| | - Amelie Harle
- Department of Medical OncologyPoole Hospital NHS Foundation TrustPooleUK
| | - Chris Todd
- School of Health SciencesUniversity of ManchesterUK
- Manchester Academic Health Science CentreUK
- Manchester University Foundation NHS TrustUK
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187
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Macdonald S, Conway E, Bikker A, Browne S, Robb K, Campbell C, Steele RJ, Weller D, Macleod U. Making sense of bodily sensations: Do shared cancer narratives influence symptom appraisal? Soc Sci Med 2019; 223:31-39. [PMID: 30703697 DOI: 10.1016/j.socscimed.2018.12.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 12/04/2018] [Accepted: 12/23/2018] [Indexed: 01/22/2023]
Abstract
Though new or altered bodily sensations are a common occurrence they rarely transition to biomedically defined symptoms. When they do, sensations are subject to an appraisal process that can culminate in help-seeking. The transition has particular relevance for cancer diagnoses. Studies of 'symptom appraisal' in cancer patients typically conclude that failure to regard sensations as serious or 'symptom misattribution' results in lengthier help-seeking intervals. Though multiple influences on appraisal processes are acknowledged, including the socio-cultural context, detailed description and analyses of how socio-cultural factors shape appraisal is lacking. In this paper we explore one substantial component of the sociocultural context, namely, publicly recognised shared cancer narratives, and their impact on appraisal. We undertook a secondary analysis of 24 interviews with Scottish colorectal cancer patients originally completed in 2006-2007. Our analysis showed that fear, death and severity dominated cancer narratives and were frequently restated throughout interviews. Yet, early bodily changes were often mild and vague, were commonly experienced in the context of 'feeling well' and failed to match preconceived ideas of what cancer 'feels like'. Moreover, few perceived themselves to be 'at risk' of cancer and diagnoses were characterised as 'shocking' events. Participants engaged in self-monitoring strategies and severe or painful changes prompted help-seeking. Far from misattributing symptoms, responses to bodily changes were sensible and measured; responses are particularly apt in relation to current policy rhetoric, which urges measured use of services. Our findings have resonance across healthcare settings as patients are required to negotiate a narrow and challenging space when making decisions to seek help. There is a pressing need for a more realistic approach to symptom appraisal in order to reduce help-seeking intervals. Future awareness campaigns should emphasise the importance of vague/minor bodily changes although this will necessitate discussions with health professionals on referral thresholds to achieve earlier detection.
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Affiliation(s)
- Sara Macdonald
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK.
| | - Elaine Conway
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Annemieke Bikker
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Susan Browne
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Kathryn Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Christine Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Robert Jc Steele
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - David Weller
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Una Macleod
- Hull York Medical School, University of Hull, Hull, HU6 7RX, UK
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188
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Gartland N, Long H, Skevington SM. Undiagnosed cancer symptoms in the community: does poor quality of life influence the decision to seek help? Qual Life Res 2019; 28:1327-1335. [PMID: 30671707 PMCID: PMC6470111 DOI: 10.1007/s11136-018-2088-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Although a cancer diagnosis is linked with decrements to quality of life (QoL), it is unknown exactly when QoL starts to deteriorate, and whether this occurs during the pre-diagnostic pathway. This study aimed to examine QoL during this phase, and in addition investigate whether QoL levels influence decisions about seeking professional help. This is important, because early diagnosis is linked to lower cancer mortality rates. METHODS Working alongside a Cancer Research UK Roadshow in socially deprived communities, the recent QoL of adult visitors was assessed, before attending primary care. Using a cross-sectional design, we compared QoL in those presenting a potential cancer symptom/sign, with others seeking lifestyle advice to reduce cancer risk. Self-reported QoL (WHOQOL-BREF), and intention to seek help, were measured. RESULTS Of 107 recruited, 50% were men. The potential cancer symptom group reported significantly poorer general QoL and psychological QoL, than lifestyle controls. Prior poorer physical QoL predicted stronger intentions to consult a general practitioner (GP) in the next 2 weeks, when controlling for symptom presence. CONCLUSIONS QoL is poorer for those with potential cancer symptoms, before they first seek advice from primary care. Poorer physical QoL is associated with stronger intentions to make a GP appointment. An implication for longer term health is that if public awareness about the impact of symptoms on QoL was raised, this could provide an impetus to seek help.
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Affiliation(s)
- Nicola Gartland
- Manchester Centre for Health Psychology and International Hub for Quality of Life Research (IHQoLR), Faculty of Biology, Medicine and Health, University of Manchester, Manchester, MP13 9PL, UK.
| | - Hannah Long
- Manchester Centre for Health Psychology and International Hub for Quality of Life Research (IHQoLR), Faculty of Biology, Medicine and Health, University of Manchester, Manchester, MP13 9PL, UK
| | - Suzanne M Skevington
- Manchester Centre for Health Psychology and International Hub for Quality of Life Research (IHQoLR), Faculty of Biology, Medicine and Health, University of Manchester, Manchester, MP13 9PL, UK
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189
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Flanagan JM, Skrobanski H, Shi X, Hirst Y. Self-Care Behaviors of Ovarian Cancer Patients Before Their Diagnosis: Proof-of-Concept Study. JMIR Cancer 2019; 5:e10447. [PMID: 30664464 PMCID: PMC6354198 DOI: 10.2196/10447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/30/2018] [Accepted: 11/02/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Longer patient intervals can lead to more late-stage cancer diagnoses and higher mortality rates. Individuals may delay presenting to primary care with red flag symptoms and instead turn to the internet to seek information, purchase over-the-counter medication, and change their diet or exercise habits. With advancements in machine learning, there is the potential to explore this complex relationship between a patient's symptom appraisal and their first consultation at primary care through linkage of existing datasets (eg, health, commercial, and online). OBJECTIVE Here, we aimed to explore feasibility and acceptability of symptom appraisal using commercial- and health-data linkages for cancer symptom surveillance. METHODS A proof-of-concept study was developed to assess the general public's acceptability of commercial- and health-data linkages for cancer symptom surveillance using a qualitative focus group study. We also investigated self-care behaviors of ovarian cancer patients using high-street retailer data, pre- and postdiagnosis. RESULTS Using a high-street retailer's data, 1118 purchases-from April 2013 to July 2017-by 11 ovarian cancer patients and one healthy individual were analyzed. There was a unique presence of purchases for pain and indigestion medication prior to cancer diagnosis, which could signal disease in a larger sample. Qualitative findings suggest that the public are willing to consent to commercial- and health-data linkages as long as their data are safeguarded and users of this data are transparent about their purposes. CONCLUSIONS Cancer symptom surveillance using commercial data is feasible and was found to be acceptable. To test efficacy of cancer surveillance using commercial data, larger studies are needed with links to individual electronic health records.
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Affiliation(s)
- James M Flanagan
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Hanna Skrobanski
- Institute of Epidemiology and Public Health, Research Department of Behavioural Science and Health, University College London, London, United Kingdom
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Xin Shi
- Business School, Manchester Metropolitan University, Manchester, United Kingdom
- School of Management, Shanghai University, Shanghai, China
- Karaganda State Medical University, Karaganda, Kazakhstan
| | - Yasemin Hirst
- Institute of Epidemiology and Public Health, Research Department of Behavioural Science and Health, University College London, London, United Kingdom
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190
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Emery JD, Murray SR, Walter FM, Martin A, Goodall S, Mazza D, Habgood E, Kutzer Y, Barnes DJ, Murchie P. The Chest Australia Trial: a randomised controlled trial of an intervention to increase consultation rates in smokers at risk of lung cancer. Thorax 2019; 74:362-370. [PMID: 30630891 PMCID: PMC6484693 DOI: 10.1136/thoraxjnl-2018-212506] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/26/2018] [Accepted: 12/03/2018] [Indexed: 12/11/2022]
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. Trial registration number Australian New Zealand Clinical Trial Registry (1261300039 3752). This was registered pre-results.
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Affiliation(s)
- Jon D Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia.,Department of General Practice, The Medical School, University of Western Australia, Perth, Australia.,The Primary Care Unit, Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sonya R Murray
- Department of General Practice, The Medical School, University of Western Australia, Perth, Australia
| | - Fiona M Walter
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia.,Department of General Practice, The Medical School, University of Western Australia, Perth, Australia.,The Primary Care Unit, Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Andrew Martin
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Emily Habgood
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Yvonne Kutzer
- Department of General Practice, The Medical School, University of Western Australia, Perth, Australia.,School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - David John Barnes
- Royal Prince Alfred Hospital, Newtown, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Murchie
- The Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
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191
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Cassim S, Chepulis L, Keenan R, Kidd J, Firth M, Lawrenson R. Patient and carer perceived barriers to early presentation and diagnosis of lung cancer: a systematic review. BMC Cancer 2019; 19:25. [PMID: 30621616 PMCID: PMC6323678 DOI: 10.1186/s12885-018-5169-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/02/2018] [Indexed: 01/17/2023] Open
Abstract
Background Lung cancer is typically diagnosed at a late stage. Early presentation and detection of lung cancer symptoms is critical to improving survival but can be clinically complicated and as yet a robust screening method for diagnosis is not available in routine practice. Accordingly, the barriers to help-seeking behaviour and diagnosis need to be considered. This review aimed to document the barriers to early presentation and diagnosis of lung cancer, based on patient and carer perspectives. Methods A systematic review of databases was performed for original, English language articles discussing qualitative research on patient perceived barriers to early presentation and diagnosis of lung cancer. Three major databases were searched: Scopus, PubMed and EBSCOhost. References cited in the selected studies were searched for further relevant articles. Results Fourteen studies met inclusion criteria for review. Barriers were grouped into three categories: healthcare provider and system factors, patient factors and disease factors. Conclusions Studies showed that the most frequently reported barriers to early presentation and diagnosis of lung cancer reported by patients and carers related to poor relationships between GPs and patients, a lack of access to services and care for patients, and a lack of awareness of lung cancer symptoms and treatment. Addressing these barriers offers opportunities by which rates of early diagnosis of lung cancer may be improved.
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Affiliation(s)
- Shemana Cassim
- Waikato Medical Research Centre, University of Waikato, Hamilton, 3240, New Zealand.
| | - Lynne Chepulis
- Waikato Medical Research Centre, University of Waikato, Hamilton, 3240, New Zealand
| | - Rawiri Keenan
- School of Nursing, University of Auckland, Auckland, 1023, New Zealand
| | - Jacquie Kidd
- School of Nursing, University of Auckland, Auckland, 1023, New Zealand
| | - Melissa Firth
- Waikato Medical Research Centre, University of Waikato, Hamilton, 3240, New Zealand
| | - Ross Lawrenson
- Waikato Medical Research Centre, University of Waikato, Hamilton, 3240, New Zealand.,Waikato Medical Research Centre, Waikato DHB Campus, Waikato Hospital, Hamilton, 3240, New Zealand
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192
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Humphrys E, Burt J, Rubin G, Emery JD, Walter FM. The influence of health literacy on the timely diagnosis of symptomatic cancer: A systematic review. Eur J Cancer Care (Engl) 2019; 28:e12920. [PMID: 30324636 PMCID: PMC6559266 DOI: 10.1111/ecc.12920] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 06/25/2018] [Accepted: 08/19/2018] [Indexed: 11/02/2022]
Abstract
Low health literacy has been associated with poor cancer screening uptake, difficulty in making treatment choices and reduced quality of life following a cancer diagnosis, yet it is unclear whether and how health literacy influences the pathway to diagnosis for patients with cancer symptoms. This systematic review aimed to evaluate the influence of health literacy on the timely diagnosis of symptomatic cancer. Literature was searched between January 1990 and May 2017 using MEDLINE, Embase, Scopus, ASSIA, CINAHL and PsycINFO. Only three papers met the inclusion criteria. These reported two qualitative studies and one quantitative, with adult patients diagnosed with gastrointestinal (colon, rectum and pancreas), cervical and breast cancer. The definition and assessment of health literacy varied between the studies, as did the descriptions of the pathway to diagnosis. Due to the methodological weaknesses identified, the conclusions are limited; however, the studies did highlight important considerations in the definition and measurement of health literacy. Further research is required that clearly defines health literacy and follows the principles of the Aarhus Statement to assess the influence of health literacy on the pathway to cancer diagnosis. The protocol for this review was registered with PROSPERO (CRD42016048917).
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Affiliation(s)
- Elka Humphrys
- Primary Care Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Jenni Burt
- Cambridge Centre for Health Services ResearchDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Greg Rubin
- Institute of Health and SocietySir James Spence Institute, Newcastle UniversityNewcastle upon TyneUK
| | - Jon D. Emery
- Department of General Practice and Centre for Cancer ResearchUniversity of Melbourne, Victorian Comprehensive Cancer CentreMelbourneVictoriaAustralia
| | - Fiona M. Walter
- Primary Care Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
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193
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Tookey S, Renzi C, Waller J, von Wagner C, Whitaker KL. Using the candidacy framework to understand how doctor-patient interactions influence perceived eligibility to seek help for cancer alarm symptoms: a qualitative interview study. BMC Health Serv Res 2018; 18:937. [PMID: 30514369 PMCID: PMC6278141 DOI: 10.1186/s12913-018-3730-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/19/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND 'Candidacy' is concerned with the way people consider their eligibility for accessing health services. We used the Candidacy Framework to explore how the doctor-patient relationship can influence perceived eligibility to visit their General Practitioner (GP) among people experiencing cancer alarm symptoms. METHODS We carried out a secondary analysis of qualitative interviews with 29 women and 33 men, aged ≥50 years experiencing cancer alarm symptoms, recruited through primary care. Interviews focused on symptom experience, help-seeking and primary care use. Framework analysis was used to analyse transcripts with a focus on GP-patient interactions. RESULTS Perceived (im)permeability of services acted as a barrier to help-seeking, due to limited availability of appointments, time-limited communication and difficulties asserting candidacy. There was also a focal role of communication in building a positive doctor-patient relationship, with some participants describing resisting offers of appointments as a result of previous negative GP adjudication. These factors not only influenced the current consultation but had longer-term consequences for future consultation. CONCLUSIONS Candidacy provides a valuable theoretical framework to understand the interactional factors of the doctor-patient relationship which influence perceived eligibility to seek help for possible cancer alarm symptoms. We have highlighted areas for targeted interventions to improve patient-centred care and improve earlier diagnosis.
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Affiliation(s)
- Sara Tookey
- Department of Behavioural Science and Health, University College London, WC1E 6BT, London, UK
| | - Cristina Renzi
- Department of Behavioural Science and Health, University College London, WC1E 6BT, London, UK
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, WC1E 6BT, London, UK
| | - Christian von Wagner
- Department of Behavioural Science and Health, University College London, WC1E 6BT, London, UK
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194
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Doll KM, Khor S, Odem-Davis K, He H, Wolff EM, Flum DR, Ramsey SD, Goff BA. Role of bleeding recognition and evaluation in Black-White disparities in endometrial cancer. Am J Obstet Gynecol 2018; 219:593.e1-593.e14. [PMID: 30291839 DOI: 10.1016/j.ajog.2018.09.040] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/24/2018] [Accepted: 09/25/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Advanced stage at diagnosis is an independent, unexplained contributor to racial disparity in endometrial cancer. OBJECTIVE We sought to investigate whether, prior to diagnosis, provider recognition of the cardinal symptom of endometrial cancer, postmenopausal bleeding, differs by patient race. STUDY DESIGN Black and White women diagnosed with endometrial cancer (2001 through 2011) from Surveillance, Epidemiology, and End Results-Medicare who had at least 2 years of claims prior to diagnosis were identified. Bleeding diagnoses along with procedures done prior to diagnosis were captured via claims data. Multinomial logistic regression was used to evaluate the association of race with diagnostic workup and multivariate models built to determine the association of appropriate diagnostic procedures with stage at diagnosis. RESULTS In all, 4354 White and 537 Black women diagnosed with endometrial cancer were included. Compared to White women, Black women were less likely to have guideline-concordant care: postmenopausal bleeding and appropriate diagnostic evaluation (70% vs 79%, P < .001), with adjusted relative risk ratios of 1.12-1.73 for different nonguideline-concordant pathways: bleeding without diagnostic procedures, alternative bleeding descriptions, and neither bleeding nor procedures. These pathways were associated with higher odds of advanced stage at diagnosis (adjusted odds ratio, 1.90-2.88). CONCLUSION The lack of recognition and evaluation of postmenopausal bleeding is associated with advanced stage at diagnosis in endometrial cancer. Older Black women are at highest risk for the most aggressive histology types, yet they are less likely to have guideline-concordant evaluation of vaginal bleeding. Efforts aimed at improving recognition-among patients and providers-of postmenopausal bleeding in Black women could substantially reduce disparities in endometrial cancer.
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Affiliation(s)
- Kemi M Doll
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA.
| | - Sara Khor
- Department of Surgery, University of Washington, Seattle, WA
| | | | - Hao He
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA
| | - Erika M Wolff
- Department of Surgery, University of Washington, Seattle, WA
| | - David R Flum
- Department of Surgery, University of Washington, Seattle, WA
| | | | - Barbara A Goff
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
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195
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Grosse Frie K, Kamaté B, Traoré CB, Ly M, Mallé B, Coulibaly B, Wienke A, Kantelhardt EJ. Factors associated with time to first healthcare visit, diagnosis and treatment, and their impact on survival among breast cancer patients in Mali. PLoS One 2018; 13:e0207928. [PMID: 30496219 PMCID: PMC6264812 DOI: 10.1371/journal.pone.0207928] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 11/08/2018] [Indexed: 01/26/2023] Open
Abstract
Objective To analyse patient and healthcare system related factors influencing the time to first healthcare visit, diagnosis and treatment of breast cancer patients in sub-Saharan Africa and the impact on survival in order to advise on early detection strategies. Methods A prospective hospital cohort study was conducted at the only pathology department in Mali, at the University Hospital in Bamako. All the female patients with a breast cancer diagnosis between January and April 2016 were interviewed with a structured questionnaire (N = 64) to gather information about breast symptom recognition and first healthcare visit. Information on beginning of treatment and survival were collected at 18-months follow-up. Simple Cox regression analyses were performed. Results The median time to first healthcare visit was 4.8 months, from first healthcare visit to diagnosis was 0.9 months and for the patients who started treatment (N = 46) the time from diagnosis to treatment was 1.3 months. Knowledge of breast-self-examination and correct symptom interpretation increased the chance of an earlier healthcare visit. Prolonged time to diagnosis was found with shorter duration to first healthcare visit, for working women compared to housewives and for those living within Bamako. Living outside Bamako and smaller tumour size (T1/T2) prolonged time to treatment. Visit of a traditional healer and larger tumour size (T3/T4) shortened survival time, whereas time to first healthcare visit and subsequent time to diagnosis had no influence on survival. Conclusions Down-staging strategies are only useful if the continuum of breast cancer care is warranted for the majority of patients.
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Affiliation(s)
- Kirstin Grosse Frie
- Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- * E-mail:
| | - Bakarou Kamaté
- Institut of Pathology, University Hospital Point G, Bamako, Mali
| | | | - Madani Ly
- Oncology Department, Hôpital Luxemburg, Bamako, Mali
| | - Brahima Mallé
- Institut of Pathology, University Hospital Point G, Bamako, Mali
| | | | - Andreas Wienke
- Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Eva Johanna Kantelhardt
- Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Department of Gynaecology, University Hospital Halle (Saale), Germany
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196
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Diagnosis and referral delays in primary care for oral squamous cell cancer: a systematic review. Br J Gen Pract 2018; 69:e112-e126. [PMID: 30455220 DOI: 10.3399/bjgp18x700205] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/28/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The incidence of oral cancer is increasing. Guidance for oral cancer from the National Institute for Health and Care Excellence (NICE) is unique in recommending cross-primary care referral from GPs to dentists. AIM This review investigates knowledge about delays in the diagnosis of symptomatic oral squamous cell carcinoma (OSCC) in primary care. DESIGN AND SETTING An independent multi-investigator literature search strategy and an analysis of study methodologies using a modified data extraction tool based on Aarhus checklist criteria relevant to primary care. METHOD The authors conducted a focused systematic review involving document retrieval from five databases up to March 2018. Included were studies looking at OSCC diagnosis from when patients first accessed primary care up to referral, including length of delay and stage of disease at time of definitive diagnosis. RESULTS From 538 records, 16 articles were eligible for full-text review. In the UK, more than 55% of patients with OSCC were referred by their GP, and 44% by their dentist. Rates of prescribing between dentists and GPs were similar, and both had similar delays in referral, though one study found greater delays attributed to dentists as they had undertaken dental procedures. On average, patients had two to three consultations before referral. Less than 50% of studies described the primary care aspect of referral in detail. There was no information on inter-GP-dentist referrals. CONCLUSION There is a need for primary care studies on OSCC diagnosis. There was no evidence that GPs performed less well than dentists, which calls into question the NICE cancer option to refer to dentists, particularly in the absence of robust auditable pathways.
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197
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Fouladi N, Pourfarzi F, Daneshian A, Alimohammadi S. Mediating Factors in Early Diagnosis of Breast Cancer: from Initial Changes in Health to Breast Cancer Detection. Asian Pac J Cancer Prev 2018; 19:2751-2755. [PMID: 30360602 PMCID: PMC6291050 DOI: 10.22034/apjcp.2018.19.10.2751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Breast cancer is one of the most frequently occurring cancers in women throughout the world. In Iran, according to available reports, 70% of patients with breast cancer are detected at the advanced stages of the disease. Materials and Methods: This study is of descriptive-analytic cross-sectional type.160 female patients was selected. The data in this study was collected via face to face interview using a questionnaire based on the Anderson’s delay model. Data were analyzed using SPSS 22 and the significance level was considered to be 0.05. Results: The results showed that presence of mass was the first symptom in many of women, i.e., 76 cases (47.5%). not only the presence of mass in the breast, but also any other symptom, hadn’t been taken as a serious problem initially by women. Non-improvement of the symptoms and exacerbation of the symptoms was considered as a symptom of illness by patients. After considering the changes as the symptoms of illness, patients had tried to treat the disease through different methods of self-treatment. The failure of the self-treatment in controlling the symptoms, had directed the patients toward seeking for medical services. Out of 160 patients, 49 patients (39.6%) changed the time of their appointment with doctor. 110 cases (68%) out of 160 patients, rather than initiating relevant diagnostic procedure related to the disease, had received non-specific and non-related therapeutic measures. Conclusion: Pondering on the results yields that patient-related delays, resulting from their lack of awareness of the disease, cultural factors, and fear, can only play an important role in postponement of visiting a physician, but in the diagnosis of disease it is the inability of general practitioners in performing differential diagnoses, and making request for related diagnostic measures which can significantly increase the lag time until the onset of the main treatment.
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Affiliation(s)
- Nasrin Fouladi
- Community Medicine, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.,Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.
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198
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Bascur-Castillo C, Araneda-Gatica V, Castro-Arias H, Carrasco-Portiño M, Ruiz-Cantero MT. Determinants in the process of seeking help for urinary incontinence in the Chilean health system. Int J Gynaecol Obstet 2018; 144:103-111. [PMID: 30267534 DOI: 10.1002/ijgo.12685] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/24/2018] [Accepted: 09/27/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To analyze via the Andersen model what leads women with urinary incontinence (UI) to seek help and remain in the healthcare system. METHODS An interpretative phenomenologic study enrolling women aged 18 years or older who were diagnosed with UI at a tertiary care hospital in Chile between January and March 2016. Data were collected by semi-structured interview. The categories explored experience with UI and reasons for seeking health care, and included the dimensions of the Andersen model. RESULTS Ten women were enrolled. Characteristics that eased or hindered healthcare seeking were identified to come from the women (frequency and quantity of symptoms, coping strategies, and beliefs about its causes) and from their environment (reaction of partner, family, or coworkers to her condition). Some were associated with primary care (human and/or technical resources) and some with secondary care (pelvic floor units). CONCLUSION The results reflect the complexities of asking for health care for women with UI, especially in a country such as Chile with different healthcare levels. Raising awareness of this complexity and developing an approach that includes all stakeholders (institution, community, and family) is crucial for professionals who want to offer both medical therapy and wellness-focused healthcare.
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Affiliation(s)
- Carolina Bascur-Castillo
- Department of Obstetrics and Puericulture, Faculty of Medicine, University of Concepción, Concepción, Chile.,Pelvic Floor Unit, Dr. Guillermo Grant Benavente Hospital, Concepción, Chile
| | | | - Henry Castro-Arias
- Pelvic Floor Unit, Dr. Guillermo Grant Benavente Hospital, Concepción, Chile.,Department of Obstetrics and Gynecology, Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Mercedes Carrasco-Portiño
- Department of Obstetrics and Puericulture, Faculty of Medicine, University of Concepción, Concepción, Chile.,Research Group on Public Health, University of Alicante, Alicante, Spain
| | - María Teresa Ruiz-Cantero
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Concepción, Concepción, Chile.,CIBER de Epidemiología y Salud Púbica, Madrid, Spain
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199
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Notman F, Porteous T, Murchie P, Bond CM. Do pharmacists contribute to patients' management of symptoms suggestive of cancer: a qualitative study. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 27:131-139. [PMID: 30251300 DOI: 10.1111/ijpp.12489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 08/17/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Limited awareness of cancer symptoms results in patient delay in seeking help and contributes to delay in diagnosis. Few UK studies have investigated the potential for community pharmacists to facilitate earlier detection of cancer. This study aimed to investigate what actions patients take to manage their early cancer symptoms, to identify the extent of current community pharmacy involvement and to consider the potential role for community pharmacists to facilitate appropriate management and appraisal of potential early cancer symptoms. METHODS Patients diagnosed with lung, colorectal or gastro-oesophageal cancer in the preceding 12 months were identified during clinic visits by consultants. Semi-structured interviews were conducted, audio-recorded, transcribed and thematically analysed, using the Framework Approach. KEY FINDINGS Twenty-five consenting patients were interviewed: two-thirds were male and more than half had lung cancer. Although all had experienced potential cancer symptoms prior to diagnosis, most underestimated seriousness and misattributed causation. Symptoms were managed by lifestyle changes and self-selecting medicines from local shops, supermarkets and pharmacies but without engaging with the pharmacist. CONCLUSIONS For symptom management, participants self-selected medicines from community pharmacies, but pharmacy staff were rarely involved. Involving community pharmacists or their staff at the point of sale of these medicines might have facilitated earlier cancer diagnosis. Further research is needed to quantify how many patients with symptoms suggestive of cancer present in community pharmacies to understand if a pharmacist's role in facilitating symptom management and appraisal of potential cancer symptoms would be acceptable and effective, before developing any interventions.
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Affiliation(s)
- Frances Notman
- Academic Primary Care, University of Aberdeen, Aberdeen, Scotland
| | - Terry Porteous
- Centre for Health Education and Research Innovation, University of Aberdeen, Aberdeen, Scotland
| | - Peter Murchie
- Academic Primary Care, University of Aberdeen, Aberdeen, Scotland
| | - Christine M Bond
- Academic Primary Care, University of Aberdeen, Aberdeen, Scotland
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200
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Malalasekera A, Dhillon HM, Blinman PL, Kao SC, Vardy JL. Delays to diagnosis and treatment of lung cancer in Australia: healthcare professional perceptions of actual versus acceptable timeframes. Intern Med J 2018; 48:1063-1071. [DOI: 10.1111/imj.13970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/15/2018] [Accepted: 05/04/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Ashanya Malalasekera
- Sydney Medical School; University of Sydney; New South Wales Australia
- Concord Cancer Centre; Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - Haryana M. Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making; The University of Sydney; New South Wales Australia
| | - Prunella L. Blinman
- Concord Cancer Centre; Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - Steven C. Kao
- Chris O’Brien Lifehouse; Sydney New South Wales Australia
| | - Janette L. Vardy
- Sydney Medical School; University of Sydney; New South Wales Australia
- Concord Cancer Centre; Concord Repatriation General Hospital; Sydney New South Wales Australia
- Centre for Medical Psychology and Evidence-based Decision-making; The University of Sydney; New South Wales Australia
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