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Frosch ZAK, Jacobs LM, O'Brien CS, Brecher AC, McKeown CJ, Lynch SM, Geynisman DM, Hall MJ, Edelman MJ, Bleicher RJ, Fang CY. "Cancer's a demon": a qualitative study of fear and multilevel factors contributing to cancer treatment delays. Support Care Cancer 2023; 32:13. [PMID: 38060063 DOI: 10.1007/s00520-023-08200-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE Delays initiating cancer therapy are increasingly common, impact outcomes, and have implications for health equity. However, it remains unclear (1) whether patients' beliefs regarding acceptable diagnostic to treatment intervals align with current guidelines, and (2) to what degree psychological factors contribute to longer intervals. We conducted a qualitative study with patients and cancer care team members ("providers"). METHODS We interviewed patients with several common solid tumors as well as providers. Interviews were analyzed using an interpretive approach, guided by modified grounded theory. RESULTS Twenty-two patients and 12 providers participated. Half of patients had breast cancer; 27% waited >60 days between diagnosis and treatment. Several themes emerged. (1) Patients felt treatment should begin immediately following diagnosis, while providers' opinion on the goal timeframe to start treatment varied. (2) Patients experienced psychological distress while waiting for treatment. (3) Participants identified logistical, social, and psychological sources of delay. Fear related to multiple aspects of cancer care was common. Emotion-driven barriers could manifest as not taking steps to move ahead, or as actions that delayed care. (4) Besides addressing logistical challenges, patients believed that education and anticipatory guidance, from their care team and from peers, may help overcome psychological barriers to treatment and facilitate the start of therapy. CONCLUSIONS Patients feel an urgency to start cancer therapy, desiring time frames shorter than those included in guidelines. Psychological distress is frequently both a contributor to, and a consequence of, treatment delays. Addressing multilevel barriers, including psychological ones, may facilitate timely treatment and reduce distress.
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Affiliation(s)
- Zachary A K Frosch
- Department of Hematology/Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
- Cancer Prevention and Control Research Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
| | - Lisa M Jacobs
- Mixed Methods Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Caroline S O'Brien
- Mixed Methods Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Alison C Brecher
- Cancer Prevention and Control Research Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Colleen J McKeown
- Cancer Prevention and Control Research Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Shannon M Lynch
- Cancer Prevention and Control Research Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Daniel M Geynisman
- Department of Hematology/Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Michael J Hall
- Department of Hematology/Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
- Cancer Prevention and Control Research Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Martin J Edelman
- Department of Hematology/Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Richard J Bleicher
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Carolyn Y Fang
- Cancer Prevention and Control Research Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
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Factors Involved in Nurses' Health-Seeking Behaviors: A Qualitative Study. ANS Adv Nurs Sci 2023; 46:E1-E15. [PMID: 36066331 DOI: 10.1097/ans.0000000000000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study aimed to explore the factors involved in Iranian nurses' health-seeking behavior. In this qualitative exploratory descriptive study, 15 nurses from hospitals affiliated to Iran and Qazvin University of Medical Sciences were interviewed from April to March 2020. Data were collected via purposive sampling by unstructured in-depth interviews and analyzed using thematic analysis. Findings identified 5 main themes, "fear," "trust/distrust," "excuse," "accessibility," and "support" that were involved in nurses' health-seeking behavior. The findings of this study may contribute to a deeper understanding of the factors involved in nurses' health-seeking behavior and pave the way for further research and policy making regarding nursing workforce health.
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Ren S, Zhang Y, Qin P, Wang J. Factors Influencing Total Delay of Breast Cancer in Northeast of China. Front Oncol 2022; 12:841438. [PMID: 35311134 PMCID: PMC8924654 DOI: 10.3389/fonc.2022.841438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Delay in diagnosis and treatment, called total delay, could probably result in lower survival rates in breast cancer patients. This study aimed to investigate the factors associated with the comprehensive delay behaviors and to evaluate its effect on outcomes in patients with breast cancer in Dalian, a northeast city of China. Methods A retrospective chart review was conducted using a cancer registry dataset including 298 patients. The Kaplan–Meier survival analysis was used to identify the threshold of total delay, dividing the patients into a group with significant uncertainty and a group without substantial delay. The factors associated with the significant total delay were investigated from the potential candidates, like income level and marital status, by using the chi-squared test. The difference of the clinicopathologic characteristics between the patients grouped by the significant total delay, like tumor size and lymph node metastasis, was also investigated to find out the effect of the total delay. Results A total of 238 charts were used for analysis. The mean age was 57.3. The median of total delays was 3.75 months. Thirty days was identified as a threshold, more than which the total delay can lead to worse survival. Patients’ marital status (p = 0.010), income levels (p = 0.003), smoking status (p = 0.031), initial visiting hospital level (p = 0.005), self-health care (p = 0.001), and self-concern about initial symptom (p ≈ 0.000) were identified as the independent predictors of the total delay. Metastasis (p ≈ 0.000) was identified as the significant result relating to the significant total delay. Conclusions A total delay of more than 30 days predicts worse survival in breast cancer patients in Dalian. Several factors, like patients’ marital status and income levels, can be considered to be relevant to the significant total delay. We recommend that these factors be used to predict the potential patients with the significant total delay in the clinical practice.
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Affiliation(s)
- Sihang Ren
- Department of Breast Surgery, Institute of Breast Disease, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yuting Zhang
- Dalian No.3 People's Hospital, Dalian Medical University, Dalian, China
| | - Pan Qin
- Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian, China
| | - Jia Wang
- Department of Breast Surgery, Institute of Breast Disease, The Second Hospital of Dalian Medical University, Dalian, China
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Legrand A, Quintard B, Garrouteigt C, Beylot-Barry M, Broc G. From neglect to earlier diagnosis: a qualitative meta-synthesis of psycho-social factors associated with consultation delay in advanced basal cell carcinoma. PSYCHOL HEALTH MED 2021; 27:1793-1804. [PMID: 34251919 DOI: 10.1080/13548506.2021.1952281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Local malignant potential of basal cell carcinoma (BCC) can lead at advanced stages to the destruction of underlying tissues and significant morbidity. The primary risk factor for progression of advanced basal cell carcinoma (aBCC) is the long duration of the tumour, which results from delay in seeking medical care. To assess the implication of psycho-social factors in the delay before the first medical consultation among patients with aBCC, in order to identify potentially targetable factors enabling earlier diagnosis. Three-step qualitative meta-synthesis: (1) systematic review of the literature; (2) structured qualitative analysis of these documents; (3) construction of a logical model. After screening, 81 articles were included. Self-neglect and denial in patients are roundly put forward as the main obstacles to consultation. We found that avoidance behaviour, mistaken interpretation and banalisation of symptoms, and fear of treatment all played a role. The strongest motivation to seek help comes from the realisation that new symptoms may be dangerous; the role of interpersonal surroundings is highlighted as helpful. Patient delay has multifactorial origins in aBCC, especially self-neglect ranging from denial of tumours to conscious refusal of treatment.
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Affiliation(s)
- A Legrand
- Department of Dermatology, Bordeaux University Hospital, Bordeaux University, Bordeaux, France
| | - B Quintard
- INSERM U1219, Bordeaux Population Health Research Centre, Team: Handicap, Activity, Cognition, Health, Bordeaux, France
| | - C Garrouteigt
- Department of Dermatology, Bordeaux University Hospital, Bordeaux University, Bordeaux, France
| | - M Beylot-Barry
- Department of Dermatology, Bordeaux University Hospital, Bordeaux University, Bordeaux, France.,INSERM U1053, UMR Bariton, Oncogenesis of Cutaneous Lymphoma, University of Bordeaux, Bordeaux, France
| | - G Broc
- Department of Psychology, Paul Valéry Montpellier 3, University of Montpellier, Montpellier, France
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Kowalski L. Functional Decline as an Indicator of Ill-Health: A Retrospective Case Study of the Process Leading to Lung Cancer. J Multidiscip Healthc 2021; 14:919-927. [PMID: 33948085 PMCID: PMC8088295 DOI: 10.2147/jmdh.s295498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/07/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Lung cancer claims more lives than any cancer in the world and remains difficult to diagnosis at early stages. Detecting lung cancer is challenging due to nonspecific symptom presentation. Literature was reviewed to consider functional decline as an indicator for ill-health. This study explored the process experienced from recognition in a change of health to receiving a lung cancer diagnosis from a patient’s perspective in order to examine this phase through a biopsychosocial lens. Patients and Methods A single-case design methodology was used for this study. The method of data collection was semi-structured interviews with people diagnosed with lung cancer utilizing criterion sampling. The case study was bound by diagnostic and geographical factors to frame the single-case: participants were limited to those living in Alaska diagnosed with stage III or stage IV lung cancer. Results One (n = 1) person participated in this study. Themes consistent with lung cancer detection process from a patient’s perspective include symptom denial, symptom reductionism, and gradual impact on function. Conclusion Although the number of participants was extremely limited due to the COVID-19 pandemic at the time of recruitment, this case study suggests a decline in function present prior to being diagnosed with lung cancer. Opportunities exist within the provider and patient interface to promote earlier detection include educating medical providers to ask specific, closed-ended, non-disease related functional questions to ascertain more details and a holistic representation of patients’ health. Raising public awareness of lung cancer symptoms, such as fatigue and dyspnea, is also warranted.
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Affiliation(s)
- Lesleigh Kowalski
- Department of Family Medicine, University of Washington, Seattle, WA, 98195, USA
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Time-to-Treatment in Oral Cancer: Causes and Implications for Survival. Cancers (Basel) 2021; 13:cancers13061321. [PMID: 33809427 PMCID: PMC8000007 DOI: 10.3390/cancers13061321] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 12/24/2022] Open
Abstract
The purpose of this review was to identify and describe the causes that influence the time-intervals in the pathway of diagnosis and treatment of oral cancer and to assess its impact on prognosis and survival. The review was structured according to the recommendations of the Aarhus statement, considering original data from individual studies and systematic reviews that reported outcomes related to the patient, diagnostic and pre-treatment intervals. The patient interval is the major contributor to the total time-interval. Unawareness of signs and/or symptoms, denial and lack of knowledge about oral cancer are the major contributors to the process of seeking medical attention. The diagnostic interval is influenced by tumor factors, delays in referral due to higher number of consultations and previous treatment with different medicines or dental procedures and by professional factors such as experience and lack of knowledge related to the disease and diagnostic procedures. Patients with advanced stage disease, primary treatment with radiotherapy, treatment at an academic facility and transitions in care are associated with prolonged pre-treatment intervals. An emerging body of evidence supports the impact of prolonged pre-treatment and treatment intervals with poorer survival from oral cancer.
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Mwaliko E, Van Hal G, Bastiaens H, Van Dongen S, Gichangi P, Otsyula B, Naanyu V, Temmerman M. Early detection of cervical cancer in western Kenya: determinants of healthcare providers performing a gynaecological examination for abnormal vaginal discharge or bleeding. BMC FAMILY PRACTICE 2021; 22:52. [PMID: 33706721 PMCID: PMC7953728 DOI: 10.1186/s12875-021-01395-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/09/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND In western Kenya, women often present with late-stage cervical cancer despite prior contact with the health care system. The aim of this study was to predict primary health care providers' behaviour in examining women who present with abnormal discharge or bleeding. METHODS This was a cross-sectional survey using the theory of planned behaviour (TPB). A sample of primary health care practitioners in western Kenya completed a 59-item questionnaire. Structural equation modelling was used to identify the determinants of providers' intention to perform a gynaecological examination. Bivariate analysis was conducted to investigate the relationship between the external variables and intention. RESULTS Direct measures of subjective norms (DMSN), direct measures of perceived behavioural control (DMPBC), and indirect measures of attitude predicted the intention to examine patients. Negative attitudes toward examining women had a suppressor effect on the prediction of health workers' intentions. However, the predictors of intention with the highest coefficients were the external variables being a nurse (β = 0.32) as opposed to a clinical officer and workload of attending less than 50 patients per day (β = 0.56). In bivariate analysis with intention to perform a gynaecological examination, there was no evidence that working experience, being female, having a lower workload, or being a private practitioner were associated with a higher intention to conduct vaginal examinations. Clinical officers and nurses were equally likely to examine women. CONCLUSIONS The TPB is a suitable theoretical basis to predict the intention to perform a gynaecological examination. Overall, the model predicted 47% of the variation in health care providers' intention to examine women who present with recurrent vaginal bleeding or discharge. Direct subjective norms (health provider's conformity with what their colleagues do or expect them to do), PBC (providers need to feel competent and confident in performing examinations in women), and negative attitudes toward conducting vaginal examination accounted for the most variance. External variables in this study also contributed to the overall variance. As the model in this study could not explain 53% of the variance, investigating other external variables that influence the intention to examine women should be undertaken.
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Affiliation(s)
- Emily Mwaliko
- Department of Reproductive Health, School of Medicine, Moi University, Box 4606, Eldoret, 30100 Kenya
| | - Guido Van Hal
- Epidemiology and Social Medicine, Social Epidemiology and Health Policy, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium
| | - Hilde Bastiaens
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Gouverneur Kinsbergen Centrum, Doornstraat 331 - 2610 Wilrijk, Antwerp, Belgium
| | - Stefan Van Dongen
- Department of Biology, Evolutionary Ecology Group, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Peter Gichangi
- DVC Academic Research & Extension, Technical University of Mombasa, Mumbasa, Kenya
- Ghent University, Ghent, Belgium
| | - Barasa Otsyula
- Department of Surgery, School of Medicine, Moi University, P.O. Box 4606, Eldoret, 30100 Kenya
| | - Violet Naanyu
- Department of Sociology Psychology and Anthropology, School of Arts and Social Sciences, Moi University, P.O. Box 3900, Eldoret, 30100 Kenya
| | - Marleen Temmerman
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Obstetrics and Gynaecology, Aga Khan University, P O. Box 00100, Nairobi, Kenya
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Mambu TNM, Kayembe PK, Malengreau M, Lapika BD. Perceptions of Health Warning Signs in Seriously Ill Woman of Childbearing Age in Kinshasa. Health (London) 2021. [DOI: 10.4236/health.2021.138068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jackson SE, Yang L, Koyanagi A, Stubbs B, Veronese N, Smith L. Declines in Sexual Activity and Function Predict Incident Health Problems in Older Adults: Prospective Findings from the English Longitudinal Study of Ageing. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:929-940. [PMID: 31432361 PMCID: PMC7058559 DOI: 10.1007/s10508-019-1443-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 05/06/2023]
Abstract
The objective of this study was to investigate cross-sectional and longitudinal associations between declines in sexual activity and function and health outcomes in a large population-based sample of older adults. Data were from 2577 men and 3195 women aged ≥ 50 years participating in the English Longitudinal Study of Ageing. Past-year changes in sexual desire, frequency of sexual activity, and ability to have an erection (men)/become sexually aroused (women) were assessed at baseline by self-completion questionnaire. Health outcomes (self-rated health, limiting long-standing illness, doctor-diagnosed diseases of the vascular system, and cancer) were self-reported at baseline (2012/2013) and 4-year follow-up (2016/2017). Data were analyzed using logistic regression, adjusted for sociodemographics, health behaviors, and depressive symptoms. Prospectively, men who reported a decline in sexual desire had higher odds of incident limiting long-standing illness (OR 1.41, 95% CI 1.04-1.91) and incident cancer (OR 1.63, 95% CI 1.06-2.50) than those who maintained their sexual desire. Men who reported a decline in the frequency of sexual activities had higher odds of deterioration in self-rated health (OR 1.47, 95% CI 1.04-2.08) and incident limiting long-standing illness (OR 1.69, 95% CI 1.20-2.37). In women, a decline in frequency of sexual activities was associated with deterioration of self-rated health (OR 1.64, 95% CI 1.07-2.51). Erectile dysfunction was longitudinally associated with poorer health outcomes including incident cancer (OR 1.73, 95% CI 1.11-2.70), coronary heart disease (OR 2.29, 95% CI 1.29-4.07), and fair/poor self-rated health (OR 1.66, 95% CI 1.19-2.32). Practitioners should be mindful that a decline in sexual activity, desire, or function in older age may be an important indicator of future adverse health outcomes.
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Affiliation(s)
- Sarah E Jackson
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
| | - Lin Yang
- Department of Epidemiology, Center for Public Health, Vienna, Austria
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Nicola Veronese
- Consiglio Nazionale delle Ricerche Area della Ricerca di Padova, Neuroscience Institut, Padua, Italy
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
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Grimley CE, Kato PM, Grunfeld EA. Health and health belief factors associated with screening and help-seeking behaviours for breast cancer: A systematic review and meta-analysis of the European evidence. Br J Health Psychol 2019; 25:107-128. [PMID: 31876992 DOI: 10.1111/bjhp.12397] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 10/28/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this systematic review was to identify health or health belief factors associated with mammography attendance or with self-initiated medical help-seeking for breast cancer symptoms among women in Europe. METHODS Five databases were searched for articles published between 2005 and 2018. Meta-analyses were conducted for 13 factors related to screening attendance and two factors associated with help-seeking behaviour. Where there were too few studies to include in the meta-analysis, a narrative synthesis was undertaken. RESULTS Sixty-five studies were included. Never having had cervical screening (d = -.72, p < .001) and higher perceived barriers to mammography (d = -.40, p < .001) were associated with lower levels of screening attendance. Possessing health insurance (d = .49, p < .001), greater perceived benefits (d = .31, p < .001) and motivation (d = .36, p = .003) towards screening, and higher perceived seriousness (d = .24, p = .019) and susceptibility (d = .20, p = .024) towards breast cancer were associated with a higher level of screening attendance. Presenting with a non-lump symptom was associated with a longer time to presentation (d = .32, p < .001). The narrative synthesis revealed that previous benign breast disease was associated with a higher level of screening attendance but with a longer time to presentation. CONCLUSIONS The review identified key similarities in factors associated with screening and help-seeking behaviours which offer scope for combined interventions aimed at women that target both behaviours. Furthermore, the review highlighted that fewer studies have focused on help-seeking behaviour, despite two thirds of breast cancer cases being self-detected. Future research should further examine predictors of help-seeking behaviour including a focus on modifiable factors, such as BMI, and physical activity.
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Affiliation(s)
| | - Pamela M Kato
- P. M. Kato Consulting, Mountain View, California, USA
| | - Elizabeth A Grunfeld
- Department of Psychological Sciences, Birkbeck College, University of London, UK
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Mullins MA, Peres LC, Alberg AJ, Bandera EV, Barnholtz-Sloan JS, Bondy ML, Funkhouser E, Moorman PG, Peters ES, Terry PD, Schwartz AG, Lawson AB, Schildkraut JM, Cote ML. Perceived discrimination, trust in physicians, and prolonged symptom duration before ovarian cancer diagnosis in the African American Cancer Epidemiology Study. Cancer 2019; 125:4442-4451. [PMID: 31415710 DOI: 10.1002/cncr.32451] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Discrimination and trust are known barriers to accessing health care. Despite well-documented racial disparities in the ovarian cancer care continuum, the role of these barriers has not been examined. This study evaluated the association of everyday discrimination and trust in physicians with a prolonged interval between symptom onset and ovarian cancer diagnosis (hereafter referred to as prolonged symptom duration). METHODS Subjects included cases enrolled in the African American Cancer Epidemiology Study, a multisite case-control study of epithelial ovarian cancer among black women. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for associations of everyday discrimination and trust in physicians with a prolonged symptom duration (1 or more symptoms lasting longer than the median symptom-specific duration), and it controlled for access-to-care covariates and potential confounders. RESULTS Among the 486 cases in this analysis, 302 women had prolonged symptom duration. In the fully adjusted model, a 1-unit increase in the frequency of everyday discrimination increased the odds of prolonged symptom duration 74% (OR, 1.74; 95% CI, 1.22-2.49), but trust in physicians was not associated with prolonged symptom duration (OR, 0.86; 95% CI, 0.66-1.11). CONCLUSIONS Perceived everyday discrimination was associated with prolonged symptom duration, whereas more commonly evaluated determinants of access to care and trust in physicians were not. These results suggest that more research on the effects of interpersonal barriers affecting ovarian cancer care is warranted.
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Affiliation(s)
- Megan A Mullins
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Lauren C Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Anthony J Alberg
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Elisa V Bandera
- Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Melissa L Bondy
- Cancer Prevention and Population Sciences Program, Baylor College of Medicine, Houston, Texas
| | - Ellen Funkhouser
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Patricia G Moorman
- Cancer Control and Population Sciences, Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Edward S Peters
- Epidemiology Program, Louisiana State University Health Sciences Center School of Public Health, New Orleans, Louisiana
| | - Paul D Terry
- Department of Medicine, Graduate School of Medicine, University of Tennessee, Knoxville, Tennessee
| | - Ann G Schwartz
- Population Studies and Disparities Research Program, Department of Oncology, Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, Michigan
| | - Andrew B Lawson
- Hollings Cancer Center and Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Joellen M Schildkraut
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Michele L Cote
- Population Studies and Disparities Research Program, Department of Oncology, Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, Michigan
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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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Cunningham Y, Wyke S, Blyth KG, Rigg D, Macdonald S, Macleod U, Harrow S, Robb KA, Whitaker KL. Lung cancer symptom appraisal among people with chronic obstructive pulmonary disease: A qualitative interview study. Psychooncology 2019; 28:718-725. [PMID: 30693608 PMCID: PMC6492269 DOI: 10.1002/pon.5005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/18/2018] [Accepted: 01/21/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The incidence of lung cancer is four times higher in people with chronic obstructive pulmonary disease (COPD) compared with the general population. Promotion of a shorter time from symptom onset to presentation is one potential strategy for earlier lung cancer diagnosis, but distinguishing respiratory symptoms can be difficult. We investigated how the experience of COPD influences symptom appraisal and help seeking for potential lung cancer symptoms. METHODS We conducted qualitative interviews with men (n = 17) and women (n = 23) aged 40 to 83 years with COPD. Topic guides drew on the integrated symptom-response framework and covered symptom experience, interpretation, action, recognition, help seeking, evaluation, and reevaluation. We used the framework method to analyse the data. RESULTS Participants said that they attributed chest symptoms to their COPD; no other cause was considered. Participants said that family/friends noticed changes in their symptoms and encouraged help seeking. Others felt isolated by their COPD because they could not get out, were fatigued, or were embarrassed. Participants visited health professionals frequently, but increased risk of lung cancer was not discussed. CONCLUSIONS Our study provides insight into different levels of influence on symptom appraisal and targets for intervention. Greater awareness of increased lung cancer risk and support to act on symptom changes is essential and could be achieved through a concerted information campaign. Health professionals working with people with COPD could also optimise appointments to support symptom appraisal of potential lung cancer symptoms.
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Affiliation(s)
| | - Sally Wyke
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Kevin G. Blyth
- Pleural Disease UnitQueen Elizabeth University HospitalGlasgowUK
- Institute of Infection, Immunity & InflammationUniversity of GlasgowGlasgowUK
| | - Douglas Rigg
- Keppoch Medical PracticePossilpark Health & Care CentreGlasgowUK
| | - Sara Macdonald
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Una Macleod
- Faculty of Health SciencesHull York Medical SchoolHullUK
| | - Stephen Harrow
- PET/CT CentreBeatson West of Scotland Cancer CentreGlasgowUK
| | - Kathryn A. Robb
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
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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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15
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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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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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Bonsu AB, Ncama BP. Recognizing and appraising symptoms of breast cancer as a reason for delayed presentation in Ghanaian women: A qualitative study. PLoS One 2019; 14:e0208773. [PMID: 30625156 PMCID: PMC6326484 DOI: 10.1371/journal.pone.0208773] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The burden of late presentation is well established in women presenting with advanced breast cancer in Africa. This paper aims to explore the reasons for delayed presentation in Ghanaian women with breast cancer. METHOD Eleven (11) women diagnosed with advanced breast cancer were purposively sampled within three years of diagnosis at the palliative care clinic of the Komfo Anokye Teaching Hospital, Ghana. Participation was voluntary. Data was collected through in-depth interviews using a self-devised semi-structured interview guide. The interviews were conducted in "Twi" (local language), audio-tape recorded and covered the women's journey from symptom discovery to their intention to seek help. All audio-taped interviews were transcribed based on the meaning of the respondents' comments. The data was managed using Nvivo version 11 qualitative software. Data was analyzed concurrently with data collection applying the principles of thematic analysis. KEY FINDINGS All the women delayed presentation due to overlapping reasons. Symptom appraisal among the women occurred in two main stages: individual understanding of breast symptom and interactive understanding of the breast symptom. These stages were based on cognitive, psycho-cultural and social factors. The five main themes generated from the data were: symptom experience, knowledge of breast cancer, role of social life and network, coping with a breast symptom and lastly intent to seeking health care. A conceptual model was developed to illustrate the relationships among the key factors and concepts emanated from this study. CONCLUSION Recognition and appraisal of breast cancer symptom in the eleven (11) Ghanaian women interviewed in this study was poor. For instance, a painless breast lump was considered not serious until a sensory symptom appears. This led women to experience appraisal and time point intervals. To minimize the incidence of late presentation of breast cancer cases in Ghana, adequate educational intervention should be provided for Ghanaian women and their social network, and other stakeholders.
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Affiliation(s)
- Adwoa Bemah Bonsu
- Discipline of Nursing, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Busisiwe Purity Ncama
- Discipline of Nursing, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Low knowledge of osteoporosis and its risk factors in urban Indian adults from Pune city, India. Public Health Nutr 2019; 22:1292-1299. [PMID: 30612590 DOI: 10.1017/s1368980018003634] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess knowledge of osteoporosis and its risk factors and to explore associations between knowledge and various sociodemographic factors in Indian adults. DESIGN Cross-sectional study. The Revised Osteoporosis Knowledge Test (OKT) was used to assess knowledge of osteoporosis. Four scores (OKT-total, range 0-32; OKT-exercise, range 0-20; OKT-nutrition, range 0-26; OKT-risk factors, range 0-14) were generated by giving 1 point to every correct answer and 0 points for incorrect or 'not known' answers. SETTING Tertiary-care hospital in Pune city, India.ParticipantsAdults aged 40-75 years (n 477; 234 males) enrolled through voluntary routine health checks and health camps. RESULTS Mean age of the study population was 54·6 (sd 9·5) years. Half the participants were aware of osteoporosis and could correctly define it. Women showed significantly higher median OKT-total and OKT-nutrition scores than men (P0·1). CONCLUSIONS Understanding about osteoporosis and its risk factors is low in the present cohort of Indian men and women. There is need to create awareness programmes aimed at both men and women especially targeting those with lower education, lower socio-economic status and no previous exposure to osteoporosis.
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Dobson C, Russell A, Brown S, Rubin G. The role of social context in symptom appraisal and help-seeking among people with lung or colorectal symptoms: A qualitative interview study. Eur J Cancer Care (Engl) 2018; 27:e12815. [PMID: 29419943 DOI: 10.1111/ecc.12815] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2017] [Indexed: 12/01/2022]
Abstract
Prolonged diagnostic intervals are associated with poorer outcomes, and the patient interval appears to be a substantial contributor to the overall length of the diagnostic interval. This study sought to understand how the broader context of people's lives influenced symptom appraisal and help-seeking, comparing experiences by length of the patient interval. Patients referred with a suspicion of lung or colorectal cancer were invited to complete a questionnaire about their symptoms, with 26 respondents purposively sampled to take part in a semi-structured interview about their patient intervals. Embodied experience, appraisal, help-seeking decision-making and consultation were identified as component stages of the patient interval, with the factors affecting movement between these stages located in one of four contextual domains: individual experience, interpersonal relationships, healthcare system interactions and social and temporal context. The length of the patient interval was related to the type of symptom(s) experienced, discussion of symptoms with others and the social responsibilities people held during symptomatic periods. A contextual model of the patient interval illustrates the stages and domains of this interval, as grounded in the data from this study. The model has potential application to future studies examining the patient interval for a range of symptoms.
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Affiliation(s)
- C Dobson
- Institute of Health and Society, Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - A Russell
- Department of Anthropology, Durham University, Durham, Uk
| | - S Brown
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - G Rubin
- Institute of Health and Society, Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
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Morowatisharifabad MA, Rahimi T, Farajkhoda T, Fallahzadeh H, Mohebi S. Exploring the feelings of Iranian women of reproductive age about health care seeking behavior: a qualitative study. Health Promot Perspect 2018; 8:71-78. [PMID: 29423365 PMCID: PMC5797311 DOI: 10.15171/hpp.2018.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 12/12/2017] [Indexed: 11/09/2022] Open
Abstract
Background: Despite the important role of feelings in health care seeking behavior (HCSB), this subject has not yet been adequately investigated. HCSB-related feelings begin with the onset of disease symptoms and persist in different forms after treatment. The aim of current study was to explore the feelings that women of reproductive age experience when they seek health care. Methods: In this deductive, qualitative content analysis, participants were selected by purposeful sampling. Semi-structured, in-depth interviews with 17 women of reproductive age and 5 health care staffs in Qom, Iran were carried out until data saturation was achieved. Qualitative data were concurrently analyzed by deductive content analysis, using the Health Promotion Model (HPM). The MAXQDA10 software was used to manage qualitative data analysis. Results: Three main categories were drawn from data to explain the HCSB-related feelings of participants consisting of (1) feeling of inner satisfaction with the treatment with 2 subcategories including "peace of mind" and "feeling alive", (2) multiple roles of fear with 5 subcategories including "fear about the consequences of delay", "fear of having hidden diseases", "fear of unknown experiences", "fear of hearing bad news" and "fear of medical errors" and (3)uncomfortable feelings with 3 subcategories including "feeling uneasy when attending health facility", "feeling embarrassed" and "feeling worthless due to dealing the doctor". Conclusion: This study revealed that the inner feelings of women varied widely, ranging from positive or motivating feelings to negative or inhibitory ones, given their experiences with the formal health care system and the current situation of medical and health services. Highlighting patients' perceived inner satisfaction and reducing fear and uncomfortable feelings by adopting culture-based practical strategies can enhance women's HCSB.
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Affiliation(s)
| | - Tahereh Rahimi
- Department of Health Education and Promotion, School of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Tahmineh Farajkhoda
- Research Center for Nursing and Midwifery Care, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Fallahzadeh
- Department of Biostatistics and Epidemiology, Research Center of Prevention and Epidemiology of Non-Communicable Disease, School of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Siamak Mohebi
- Department of Health Education and Promotion, School of Health, Qom University of Medical Sciences, Qom, Iran
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Lewis L, Marcu A, Whitaker K, Maguire R. Patient factors influencing symptom appraisal and subsequent adjustment to oesophageal cancer: A qualitative interview study. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28857296 DOI: 10.1111/ecc.12745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2017] [Indexed: 02/06/2023]
Abstract
Oesophageal cancer (EC) is characterised by vague symptoms and is often diagnosed at an advanced stage, leading to poor outcomes. Therefore, we aimed to investigate whether there might be any patient factors contributing to delay in EC diagnosis, and focused on the symptom appraisal and help-seeking strategies of people diagnosed with EC in the UK. Semi-structured interviews were conducted with 14 patients aged >18 years with localised EC at point of diagnosis. Purposive sampling was used to include patients from 1 to 9 months post-diagnosis. Analysis of the interviews identified three main themes: Interpreting symptoms, Triggers to seeking help and Making sense of an unfamiliar cancer. Findings suggested that participants normalised symptoms or used previous health experiences as a means to interpret their symptoms. The majority of participants were not alarmed by their symptoms, mainly because they had very little knowledge of EC specific symptoms. Lack of knowledge also influenced participants' sense-making of their diagnosis. The findings highlight that the process of symptom appraisal in EC is likely to be inaccurate, which may hinder early presentation and thus diagnosis. Public health campaigns communicating EC specific symptoms, however, could shorten the appraisal period and lead to earlier diagnosis.
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Affiliation(s)
- Liane Lewis
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Afrodita Marcu
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Katriina Whitaker
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Roma Maguire
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
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Coping With Prediagnosis Symptoms of Colorectal Cancer: A Study of 244 Individuals With Recent Diagnosis. Cancer Nurs 2017; 40:145-151. [PMID: 27044057 DOI: 10.1097/ncc.0000000000000361] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) symptoms are often vague and vary in severity, intensity, type, and timing. Receipt of medical care is dependent on symptom recognition and assessment, which may impede timely diagnosis. OBJECTIVE The aim of this study was to describe and categorize how CRC patients coped with symptoms prior to seeking medical care, examine sociodemographic differences in these coping strategies, and determine the strategies associated with time to seek medical care and overall time to diagnosis. METHODS Two hundred forty-four white and African American patients in Virginia and Ohio who received a diagnosis of CRC and who experienced symptoms prior to diagnosis were administered a semistructured interview and the Brief COPE questionnaire. RESULTS Eighty-three percent used more than 1 coping strategy. Common symptom-specific coping strategies were to "wait-and-see," self-treat, and rationalize symptoms. Males were more likely to wait and see (P < .001); African Americans and Medicaid recipients were more likely to self-treat via lifestyle changes (P's < .01). Younger individuals (<50 years old) had higher Brief COPE reframing, planning, and humor scores; those with lower education and income had higher denial scores (P's < .01). Using more symptom-specific coping strategies and engaging in avoidance/denial were associated with longer time to seek medical care and overall time to diagnosis (P's < .01). CONCLUSIONS Individuals experiencing CRC symptoms use multiple, diverse coping strategies that are influenced by sociodemographic characteristics. Denial is particularly relevant for delay in seeking care and timely diagnosis. IMPLICATIONS FOR PRACTICE Public health campaigns could focus on secondary prevention of CRC by targeting at-risk groups such as males, African Americans, or Medicaid recipients, who choose waiting or self-treatment in response to initial symptoms.
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Simons G, Belcher J, Morton C, Kumar K, Falahee M, Mallen CD, Stack RJ, Raza K. Symptom Recognition and Perceived Urgency of Help-Seeking for Rheumatoid Arthritis and Other Diseases in the General Public: A Mixed Method Approach. Arthritis Care Res (Hoboken) 2017; 69:633-641. [PMID: 27389847 DOI: 10.1002/acr.22979] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/06/2016] [Accepted: 06/28/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Clinical outcomes in rheumatoid arthritis (RA) are improved if the disease is treated early. However, treatment is often significantly delayed as a result of delayed help-seeking by patients who fail to recognize its symptoms or the need for rapid medical attention. Two studies were conducted to investigate the role of symptom recognition in help-seeking for the symptoms of RA, and compared this to symptom recognition and help-seeking in angina and bowel cancer. METHODS A qualitative interview study with 31 individuals and a survey of 1,088 members of the general public (all without RA) were conducted. Both studies used vignettes describing the symptoms of RA, bowel cancer, and angina. Participants made causal attributions and rated the perceived seriousness of the symptoms and the urgency with which they would seek medical help if confronted with these symptoms. RESULTS Only a small proportion of participants in both studies recognized the symptoms of RA, whereas the symptoms of bowel cancer and angina were readily recognized by many participants and considered to be more serious and to require more rapid medical attention (Z = 14.7-34.2, P < 0.001). CONCLUSION Accurate symptom attribution and the perception that symptoms are indicative of a serious underlying condition are both important drivers for rapid help-seeking. In the case of angina and bowel cancer, recent campaigns have promoted not only recognition of symptoms and their seriousness, but also emphasized the consequences of not seeking timely help. Our results suggest that these consequences should also be addressed in any public health campaign for RA.
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Affiliation(s)
| | | | | | - Kanta Kumar
- University of Birmingham, Birmingham, and University of Manchester, Manchester, UK
| | | | | | - Rebecca J Stack
- University of Birmingham, Birmingham, and Nottingham Trent University, Nottingham, UK
| | - Karim Raza
- University of Birmingham, and Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Evangeli M, Baker LLE, Pady K, Jones B, Wroe AL. What leads some people to think they are HIV-positive before knowing their diagnosis? A systematic review of psychological and behavioural correlates of HIV-risk perception. AIDS Care 2016; 28:943-53. [PMID: 26852667 DOI: 10.1080/09540121.2016.1139040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Current HIV-risk perception refers to the extent to which individuals think they might be HIV-positive. This belief, distinct from the perceived risk about being infected with HIV in the future, is likely to have a range of important consequences. These consequences may include both psychological effects (e.g., impacts on well-being) and behavioural effects (e.g., HIV testing uptake). Given these possible outcomes, and the suggested importance of risk perception in health behaviour models, understanding the behavioural and psychological antecedents of current HIV-risk perception is crucial. This systematic review investigates the relationship between behavioural and psychological factors and current HIV-risk perception (in individuals who are unaware of their actual HIV status). Eight studies were eligible for inclusion in the review (five quantitative and three qualitative studies). Drug risk behaviour and sexual risk behaviour (both self and partner) were often associated with current HIV-risk perception, although other studies failed to show a relationship between one's own sexual risk behaviour and risk perception. Psychological factors were only rarely assessed in relation to current HIV-risk perception. Where these variables were included, there was evidence that experiencing symptoms perceived to be consistent with HIV and prompts to test were associated with increased current HIV-risk perception. These findings are consistent with the Common-Sense Model (CSM) of illness representation and self-regulation. Methodological quality criteria were rarely met for the included studies. In addition, it was often difficult to ascertain whether potentially includable studies were eligible due to imprecise definitions of HIV-risk perception. Research and practice implications are discussed, with particular emphasis on the role of risk appraisals as a potential mediator of the relationship between HIV-risk behaviour, symptoms and current HIV-risk perception.
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Affiliation(s)
- Michael Evangeli
- a Department of Psychology , Royal Holloway University of London , Egham , UK
| | - Laura L E Baker
- a Department of Psychology , Royal Holloway University of London , Egham , UK
| | - Kirsten Pady
- a Department of Psychology , Royal Holloway University of London , Egham , UK
| | - Bethanie Jones
- a Department of Psychology , Royal Holloway University of London , Egham , UK
| | - Abigail L Wroe
- a Department of Psychology , Royal Holloway University of London , Egham , UK
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Moodley J, Cairncross L, Naiker T, Momberg M. Understanding pathways to breast cancer diagnosis among women in the Western Cape Province, South Africa: a qualitative study. BMJ Open 2016; 6:e009905. [PMID: 26729392 PMCID: PMC4716174 DOI: 10.1136/bmjopen-2015-009905] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore and understand women's pathways to breast cancer diagnosis and factors influencing this journey. DESIGN AND SETTING Indepth interviews were conducted with clients at a tertiary level breast cancer clinic in Cape Town, South Africa. A thematic analysis was performed underpinned by the theoretical concepts of the Model of Pathways to Treatment framework. PARTICIPANTS 20 women were interviewed within 1 week of being diagnosed with breast cancer. RESULTS The average time between discovery of bodily changes to breast cancer diagnosis was 8.5 months. Deficits in breast self-awareness and knowledge of breast cancer symptoms delayed women's interpretation of bodily changes as being abnormal. All women first noticed breast lumps; however, many did not perceive it as abnormal until additional symptoms were present. General good health, attribution of symptoms to ageing, and past benign breast disease resulted in women being complacent about bodily changes. Disclosure to family members served as a trigger to seek healthcare. The initial type of primary level care services women accessed was influenced by perceptions of care each service provided, finances, structural factors, and personal safety related to the physical location of services. CONCLUSIONS Symptom appraisal and interpretation contributed significantly to delayed presentation. To improve timely diagnosis of breast cancer, interventions that increase women's confidence in detecting breast changes, improve knowledge of breast cancer symptoms, address myths, and encourage prompt help-seeking behaviour are required.
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Affiliation(s)
- Jennifer Moodley
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Women's Health Research Unit, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Lydia Cairncross
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Thurandrie Naiker
- Department of Radiation Oncology, University of Cape Town, Cape Town, South Africa
| | - Mariette Momberg
- Women's Health Research Unit, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Fish JA, Prichard I, Ettridge K, Grunfeld EA, Wilson C. Psychosocial factors that influence men's help-seeking for cancer symptoms: a systematic synthesis of mixed methods research. Psychooncology 2015. [PMID: 26202128 DOI: 10.1002/pon.3912] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Effectiveness of cancer control partly depends upon early identification and treatment. Men appear to be more likely to delay help-seeking for symptoms, resulting in later diagnosis. This review aims to provide a mixed research synthesis of the psychosocial barriers to and facilitators of help-seeking for cancer symptoms among men. METHODS Systematic methods were followed, including a predefined research question and search strategy. Searches retrieved 7131 international records from online databases: MEDLINE (n = 3011), PubMed (n = 471), SCOPUS (n = 896), Informit (n = 131), PsychINFO (n = 347), and Web of Science (n = 2275). Forty studies were eligible for inclusion in the review (25 qualitative studies, 11 quantitative studies, and 4 mixed-method studies). RESULTS There was strong observational evidence for several psychosocial barriers to men's help-seeking behaviour: low cancer knowledge and inaccurate symptom interpretation, embarrassment and fear, and conformity to masculine gender role norms. The strongest facilitating factor associated with men's help-seeking behaviour was encouragement and support of spouses and family members. The majority of research was qualitative and used small samples, making generalisations to the wider population difficult. CONCLUSIONS Men's help-seeking for cancer symptoms is influenced by several psychosocial factors, which, in part, may be gender-specific. Health promotion initiatives to improve help-seeking behaviour among men should aim to increase cancer knowledge, reduce embarrassment and fear, address social norms deterring timely help-seeking, and acknowledge informal help-seeking with spouses and family members. Increasing the theoretical grounding of research could aid cohesion across the research area and the design of effective health promotion interventions. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jennifer A Fish
- Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University, Bedford Park, South Australia, Australia
| | - Ivanka Prichard
- Social Health Sciences, School of Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Kerry Ettridge
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | | | - Carlene Wilson
- Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University, Bedford Park, South Australia, Australia.,Cancer Council SA, Eastwood, South Australia, Australia
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Khakbazan Z, Taghipour A, Roudsari RL, Mohammadi E, Omranipour R. Delayed presentation of self-discovered breast cancer symptoms in Iranian women: a qualitative study. Asian Pac J Cancer Prev 2015; 15:9427-32. [PMID: 25422236 DOI: 10.7314/apjcp.2014.15.21.9427] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delayed presentation of symptomatic breast cancer is a public health issue in Iran, making a major contribution to low survival. Despite the importance of this problem, current knowledge is insufficient to inform interventions to shorten patient delay. The aim of this study was to explore factors influencing patient delay in Iranian women with self-discovered breast cancer symptom. MATERIALS AND METHODS This qualitative study was conducted during 2012-2013. Purposeful sampling was used to recruit 20 Iranian women with self-discovered symptoms of breast cancer who attended the Cancer Institute of Tehran University of Medical Sciences, Tehran, Iran. Data were collected through semi-structured in-depth audiotaped interviews, which were transcribed and analyzed using conventional content analysis with MAXqda software version 10. FINDINGS Content analysis of the data revealed four main themes related to the delay in seeking medical help including: 1) attributing symptoms to the benign conditions; 2) conditional health behavior; 3) inhibiting emotional expression; and 4) barriers to access to health care systems. CONCLUSIONS These results suggest that patient delay is influenced by complex and multiple factors. Effective intervention to reduce patient delay for breast cancer should be developed by focusing on improvement of women's medical knowledge, managing patients' emotional expression and reform of the referral system.
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Affiliation(s)
- Zohreh Khakbazan
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran E-mail :
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Khakbazan Z, Roudsari RL, Taghipour A, Mohammadi E, Pour RO. Appraisal of breast cancer symptoms by Iranian women: entangled cognitive, emotional and socio-cultural responses. Asian Pac J Cancer Prev 2015; 15:8135-42. [PMID: 25338996 DOI: 10.7314/apjcp.2014.15.19.8135] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer is the most common cancer in Iranian women and usually features delayed presentation and late diagnosis. Interpretation of symptoms, as the most important step, has a significant impact on patient delay in seeking treatment. There is a dearth of studies on symptom appraisal and the process leading to seeking help in breast cancer patients. This study explored the perceptions and experiences of Iranian women with self-detected possible breast cancer symptoms. MATERIALS AND METHODS A qualitative method was conducted involving in-depth semi-structured interviews with 27 Iranian women with self-discovered breast cancer symptoms. Participants were purposefully selected from women who attended Cancer Institute of Tehran University of Medical Sciences during June 2012 to August 2013. The audiotaped interviews were transcribed and analyzed using conventional content analysis with MAXQDA soft ware version 10. The trustworthiness of the study was verified by prolonged engagement, member validation of codes, and thick description. RESULTS The main concepts emerging from data analysis were categorized in four categories: symptom recognition, labeling of symptoms, interactive understanding, and confronting the fear of cancer. Symptom recognition through breast self-examination, symptom monitoring and employing prior knowledge distinguished normal from abnormal symptoms and accompanied with perception of being at risk of breast cancer led to symptom labeling. Social interaction by selective disclosure and receiving reassurance from a consultant led to confirmation or redefinition of the situation. Perceived seriousness of the situation and social meanings of breast cancer as a stigmatized and incurable illness associated with loss of femininity were reasons for patient worries and fear. CONCLUSIONS This study emphasized that entangled cognitive, emotional and socio-cultural responses affecting understanding of symptom seriousness require further investigation. It is suggested that programs aimed at shortening patient delay in breast cancer should be focused on improving women's knowledge and self-awareness of breast cancer, in addition to correcting their social beliefs.
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Affiliation(s)
- Zohreh Khakbazan
- Department of Midwifery, Cancer Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran E-mail :
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Plouvier AOA, Olde Hartman TC, Boots LPW, Bloem BR, van Weel C, Lagro-Janssen ALM. Time intervals in diagnosing Parkinson's disease: The patients' views. PATIENT EDUCATION AND COUNSELING 2015; 98:777-782. [PMID: 25770049 DOI: 10.1016/j.pec.2015.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 12/22/2014] [Accepted: 02/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore patients' views on their pathway to the diagnosis of Parkinson's disease (PD). METHODS A qualitative study of 52 essays written by patients with PD, using comparative content analysis. RESULTS Patients divide their diagnostic pathway into three time intervals: recognition of the symptoms; the decision to seek help; and the process of diagnosing PD. Patients have difficulties recognizing the prodromal symptoms of PD (their knowledge is based on public figures with advanced PD) and mention their general practitioners do as well. The decision to seek help is influenced by the patient's attitude toward health care and by their significant others. More than half of the patients believe their diagnosis was delayed. However, the majority of all patients are satisfied with their diagnostic trajectory. CONCLUSION The pathway to diagnosing PD is an iterative process influenced by patient-, health care provider- and disease-related factors. Despite possible delay in diagnosis, patients are content with their pathway. PRACTICE IMPLICATIONS In order to facilitate earlier diagnosis and timely therapeutic intervention (in particular with regard to future possibilities for disease modifying therapy), effort is required to increase the recognition of prodromal symptoms of PD by patients, their significant others and health care providers.
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Affiliation(s)
- Annette O A Plouvier
- Department of Primary and Community Care, Radboud university medical center Nijmegen, The Netherlands.
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud university medical center Nijmegen, The Netherlands
| | - Leontien P W Boots
- Department of Primary and Community Care, Radboud university medical center Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology and Parkinson Centre Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center Nijmegen, The Netherlands
| | - Chris van Weel
- Department of Primary and Community Care, Radboud university medical center Nijmegen, The Netherlands; Australian Primary Health Care Research Institute, Australian National University, Canberra, Australia
| | - Antoine L M Lagro-Janssen
- Department of Primary and Community Care, Radboud university medical center Nijmegen, The Netherlands
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Balasooriya-Smeekens C, Walter FM, Scott S. The role of emotions in time to presentation for symptoms suggestive of cancer: a systematic literature review of quantitative studies. Psychooncology 2015; 24:1594-604. [PMID: 25989295 DOI: 10.1002/pon.3833] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 03/30/2015] [Accepted: 04/03/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Emotions may be important in patients' decisions to seek medical help for symptoms suggestive of cancer. OBJECTIVES The aim of this systematic literature review was to examine quantitative literature on the influence of emotion on patients' help-seeking for symptoms suggestive of cancer. The objectives were to identify the following: (a) which types of emotions influence help-seeking behaviour, (b) whether these form a barrier or trigger for seeking medical help and (c) how the role of emotions varies between different cancers and populations. METHODS We searched four electronic databases and conducted a narrative synthesis. Inclusion criteria were studies that reported primary, quantitative research that examined any emotion specific to symptom appraisal or help-seeking for symptoms suggestive of cancer. RESULTS Thirty-three papers were included. The studies were heterogeneous in their methods and quality, and very few had emotion as the main focus of the research. Studies reported a limited range of emotions, mainly related to fear and worry. The impact of emotions appears mixed, sometimes acting as a barrier to consultation whilst at other times being a trigger or being unrelated to time to presentation. It is plausible that different emotions play different roles at different times prior to presentation. CONCLUSIONS This systematic review provides some quantitative evidence for the role of emotions in help-seeking behaviour. However, it also highlighted widespread methodological, definition and design issues among the existing literature. The conflicting results around the role of emotions on time to presentation may be due to the lack of definition of each specific emotion.
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Affiliation(s)
| | - Fiona M Walter
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Suzanne Scott
- Unit of Social and Behavioural Sciences, King's College London Dental Institute, London, UK
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Whitaker KL, Scott SE, Wardle J. Applying symptom appraisal models to understand sociodemographic differences in responses to possible cancer symptoms: a research agenda. Br J Cancer 2015; 112 Suppl 1:S27-34. [PMID: 25734385 PMCID: PMC4385973 DOI: 10.1038/bjc.2015.39] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Sociodemographic inequalities in the stage of diagnosis and cancer survival may be partly due to differences in the appraisal interval (time from noticing a bodily change to perceiving a reason to discuss symptoms with a health-care professional). A number of symptom appraisal models have been developed describing the psychological factors that underlie how people make sense of symptoms, although none explicitly focus on sociodemographic characteristics. METHODS We therefore conducted a conceptual review synthesising all symptom appraisal models, and focus on potential links with sociodemographics that could be the focus of future research. RESULTS Common psychological elements across nine symptom appraisal models included knowledge, attention, expectation and identity, all of which could be sensitive to sociodemographic factors. For example, lower socioeconomic status (SES), male sex and older age are associated with lower health literacy generally and lower cancer symptom knowledge. Limited attentional resources, lower expectations about health and lack of social support also hamper symptom interpretation, and would be likely to be more prevalent in those from lower SES backgrounds. Symptom heuristics ('rules of thumb') may lead to symptoms being normalised because they are common within the social network, potentially disadvantaging older populations. CONCLUSIONS A better understanding of the processes through which people interpret their symptoms, and the way these processes differ by sociodemographic factors, could help guide the development of interventions with the aim of reducing inequalities in cancer outcomes.
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Affiliation(s)
- K L Whitaker
- Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - S E Scott
- Unit of Social and Behavioural Sciences, King's College London Dental Institute, London SE5 9RW, UK
| | - J Wardle
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London WC1E 6BT, UK
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Nelissen S, Beullens K, Lemal M, Van den Bulck J. Fear of cancer is associated with cancer information seeking, scanning and avoiding: a cross-sectional study among cancer diagnosed and non-diagnosed individuals. Health Info Libr J 2015; 32:107-19. [PMID: 25809822 DOI: 10.1111/hir.12100] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 02/23/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nowadays, there is an abundance of health and cancer information in the mass media. Because of this high amount of information, it is possible for individuals to find or incidentally encounter cancer information, but it is also possible to be overloaded by this information and, consequently, to avoid it. Previous studies have indicated that fear of cancer could be both positively and negatively related to behaviours such as screening, help-seeking and information avoidance. OBJECTIVE The aims of this study were (1) to assess the relationship between fear of cancer and cancer information acquisition and avoiding behaviour, (2) to examine whether this relationship was curvilinear, and (3) to determine whether this relationship was moderated by being diagnosed with cancer or not. METHOD Six hundred and twenty-one cancer diagnosed and 1387 non-diagnosed individuals were recruited through a convenience sample in Flanders (Belgium) and filled in a standardised survey questionnaire. RESULTS The results showed a positive linear association between fear of cancer and information seeking, scanning and avoiding. Being diagnosed with cancer or not did not moderate this relationship. CONCLUSION Fear of cancer is positively associated with cancer information acquisition and avoiding behaviour. This suggests that fear of cancer predicts different behaviours in different individuals.
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Affiliation(s)
- Sara Nelissen
- Faculty of Social Sciences, Leuven School for Mass Communication Research, University of Leuven, Leuven, Belgium
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Simons G, Mallen CD, Kumar K, Stack RJ, Raza K. A qualitative investigation of the barriers to help-seeking among members of the public presented with symptoms of new-onset rheumatoid arthritis. J Rheumatol 2015; 42:585-92. [PMID: 25641894 DOI: 10.3899/jrheum.140913] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Treating patients with rheumatoid arthritis (RA) within 3 months of symptom onset leads to significantly improved clinical outcomes. However, many people with RA symptoms wait a long time before seeking medical attention. To develop effective health interventions to encourage people to seek help early, it is important to understand what the general public knows about RA, how they would react to the symptoms of RA, and what might delay help-seeking. METHODS Qualitative interviews were conducted with 38 members of the general public (32 women) without any form of inflammatory arthritis about their perceptions of RA symptoms and decisions to seek help were they to experience such symptoms. The interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. RESULTS A number of barriers and drivers to help-seeking were identified and grouped into 5 themes: perceived causes of symptoms; factors related to presentation, location, and experience of symptoms; perceived effect of symptoms on daily life; self-management of symptoms; and general practitioner-related drivers and barriers. CONCLUSION To our knowledge, our study is the first to investigate barriers to and drivers of help-seeking in response to the onset of RA symptoms in individuals without a diagnosis of RA. It has revealed a number of additional factors (e.g., the importance of the location of the symptoms) besides those previously identified in retrospective studies of patients with RA. Together with the data from previous research, these findings will help inform future health interventions aimed at increasing knowledge of RA and encouraging help-seeking.
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Affiliation(s)
- Gwenda Simons
- From the Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham; Sandwell and West Birmingham Hospitals National Health Service (NHS) Trust, Birmingham; Arthritis Research United Kingdom Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele; and the Faculty of Medical and Human Sciences, School of Nursing, University of Manchester, Manchester, UK.G. Simons, Research Fellow, PhD; R.J. Stack, Research Fellow, PhD, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham; C.D. Mallen, Professor of General Practice Research, PhD, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University; K. Kumar, National Institute for Health Research Clinical Doctoral Research Fellow, MSc, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, and the Faculty of Medical and Human Sciences, School of Nursing, University of Manchester; K. Raza, Professor of Clinical Rheumatology, Honorary Consultant Rheumatologist, PhD, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, and the Sandwell and West Birmingham Hospitals NHS Trust.
| | - Christian David Mallen
- From the Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham; Sandwell and West Birmingham Hospitals National Health Service (NHS) Trust, Birmingham; Arthritis Research United Kingdom Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele; and the Faculty of Medical and Human Sciences, School of Nursing, University of Manchester, Manchester, UK.G. Simons, Research Fellow, PhD; R.J. Stack, Research Fellow, PhD, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham; C.D. Mallen, Professor of General Practice Research, PhD, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University; K. Kumar, National Institute for Health Research Clinical Doctoral Research Fellow, MSc, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, and the Faculty of Medical and Human Sciences, School of Nursing, University of Manchester; K. Raza, Professor of Clinical Rheumatology, Honorary Consultant Rheumatologist, PhD, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, and the Sandwell and West Birmingham Hospitals NHS Trust
| | - Kanta Kumar
- From the Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham; Sandwell and West Birmingham Hospitals National Health Service (NHS) Trust, Birmingham; Arthritis Research United Kingdom Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele; and the Faculty of Medical and Human Sciences, School of Nursing, University of Manchester, Manchester, UK.G. Simons, Research Fellow, PhD; R.J. Stack, Research Fellow, PhD, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham; C.D. Mallen, Professor of General Practice Research, PhD, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University; K. Kumar, National Institute for Health Research Clinical Doctoral Research Fellow, MSc, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, and the Faculty of Medical and Human Sciences, School of Nursing, University of Manchester; K. Raza, Professor of Clinical Rheumatology, Honorary Consultant Rheumatologist, PhD, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, and the Sandwell and West Birmingham Hospitals NHS Trust
| | - Rebecca Jayne Stack
- From the Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham; Sandwell and West Birmingham Hospitals National Health Service (NHS) Trust, Birmingham; Arthritis Research United Kingdom Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele; and the Faculty of Medical and Human Sciences, School of Nursing, University of Manchester, Manchester, UK.G. Simons, Research Fellow, PhD; R.J. Stack, Research Fellow, PhD, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham; C.D. Mallen, Professor of General Practice Research, PhD, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University; K. Kumar, National Institute for Health Research Clinical Doctoral Research Fellow, MSc, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, and the Faculty of Medical and Human Sciences, School of Nursing, University of Manchester; K. Raza, Professor of Clinical Rheumatology, Honorary Consultant Rheumatologist, PhD, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, and the Sandwell and West Birmingham Hospitals NHS Trust
| | - Karim Raza
- From the Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham; Sandwell and West Birmingham Hospitals National Health Service (NHS) Trust, Birmingham; Arthritis Research United Kingdom Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele; and the Faculty of Medical and Human Sciences, School of Nursing, University of Manchester, Manchester, UK.G. Simons, Research Fellow, PhD; R.J. Stack, Research Fellow, PhD, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham; C.D. Mallen, Professor of General Practice Research, PhD, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University; K. Kumar, National Institute for Health Research Clinical Doctoral Research Fellow, MSc, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, and the Faculty of Medical and Human Sciences, School of Nursing, University of Manchester; K. Raza, Professor of Clinical Rheumatology, Honorary Consultant Rheumatologist, PhD, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, and the Sandwell and West Birmingham Hospitals NHS Trust
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Barriers to healthcare seeking, beliefs about cancer and the role of socio-economic position. A Danish population-based study. Prev Med 2015; 71:107-13. [PMID: 25524610 DOI: 10.1016/j.ypmed.2014.12.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/30/2014] [Accepted: 12/08/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cancer-related health behaviours may be affected by barriers to healthcare seeking and beliefs about cancer. The aim was to assess anticipated barriers to healthcare seeking and beliefs about cancer in a sample of the Danish population and to assess the association with socio-economic position. METHODS A population-based telephone interview with 3000 randomly sampled persons aged 30 years or older was performed using the Awareness and Beliefs about Cancer measure from 31 May to 4 July 2011. The Awareness and Beliefs about Cancer measure includes statements about four anticipated barriers to healthcare seeking and three positively and three negatively framed beliefs about cancer. For all persons, register-based information on socio-economic position was obtained through Statistics Denmark. RESULTS Two anticipated barriers, worry about what the doctor might find and worry about wasting the doctor's time, were present among 27% and 15% of the respondents, respectively. Overall, a high proportion of respondents concurred with positive beliefs about cancer; fewer concurred with negative beliefs. Having a low educational level and a low household income were strongly associated with having negative beliefs about cancer. CONCLUSION The fact that worry about what the doctor might find and worry about wasting the doctor's time were commonly reported barriers call for initiatives in general practice. The association between low educational level and low household income and negative beliefs about cancer might to some degree explain the negative socio-economic gradient in cancer outcome.
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Oberoi DV, Jiwa M, McManus A, Hodder R, de Nooijer J. Help-seeking experiences of men diagnosed with colorectal cancer: a qualitative study. Eur J Cancer Care (Engl) 2014; 25:27-37. [PMID: 25521505 DOI: 10.1111/ecc.12271] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2014] [Indexed: 01/12/2023]
Abstract
Advanced-stage diagnosis of colorectal cancer (CRC) leads to poor prognosis and reduced survival rates. The current study seeks to explore the reasons for diagnostic delays in a sample of Australian men with CRC. Semi-structured interviews were conducted in a purposive sample of 20 male CRC patients. Data collection ceased when no new data emerged. Interviews were audiotaped, transcribed and thematically analysed using Andersen's Model of Total Patient Delay as the theoretical framework. Most participants (18/20) had experienced lower bowel symptoms prior to diagnosis. Patient-related delays were more common than delays attributable to the health-care system. Data regarding patient delays fit within the first four stages of Andersen's model. The barriers to seeking timely medical advice were mainly attributed to misinterpretation of symptoms, fear of cancer diagnosis, reticence to discuss the symptoms or consulting a general practitioner. Treatment delays were a minor cause for delayed diagnosis. Delay in referral and scheduling for colonoscopy were among the system-delay factors. In many instances, delays resulted from men's failure to attribute their symptoms to cancer and, subsequently, delay in diagnosis.
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Affiliation(s)
- D V Oberoi
- Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - M Jiwa
- Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - A McManus
- Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - R Hodder
- Department of General Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - J de Nooijer
- Faculty of Health Sciences, Maastricht University, Maastricht, the Netherlands
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Khakbazan Z, Taghipour A, Latifnejad Roudsari R, Mohammadi E. Help seeking behavior of women with self-discovered breast cancer symptoms: a meta-ethnographic synthesis of patient delay. PLoS One 2014; 9:e110262. [PMID: 25470732 PMCID: PMC4254513 DOI: 10.1371/journal.pone.0110262] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 09/16/2014] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Patient delay makes a critical contribution to late diagnosis and poor survival in cases of breast cancer. Identifying the factors that influence patient delay could provide information for adopting strategies that shorten this delay. The aim of this meta-ethnography was to synthesize existing qualitative evidence in order to gain a new understanding of help seeking behavior in women with self-discovered breast cancer symptoms and to determine the factors that influence patient delay. METHODS The design was a meta-ethnography approach. A systematic search of the articles was performed in different databases including Elsevier, PubMed, ProQuest and SCOPUS. Qualitative studies with a focus on help seeking behaviors in women with self-discovered breast cancer symptoms and patient delay, published in the English language between 1990 and 2013 were included. The quality appraisal of the articles was carried out using the Critical Appraisal Skills Programme qualitative research checklist and 13 articles met the inclusion criteria. The synthesis was conducted according to Noblit and Hare's meta-ethnographic approach (1988), through reciprocal translational analysis and lines-of-argument. FINDINGS The synthesis led to identification of eight repeated key concepts including: symptom detection, initial symptom interpretation, symptom monitoring, social interaction, emotional reaction, priority of medical help, appraisal of health services and personal-environmental factors. Symptom interpretation is identified as the important step of the help seeking process and which changed across the process through active monitoring of their symptoms, social interactions and emotional reactions. The perceived seriousness of the situation, priority to receive medical attention, perceived inaccessibility and unacceptability of the health care system influenced women's decision-making about utilizing health services. CONCLUSION Help seeking processes are influenced by multiple factors. Educational programs aimed at correcting misunderstandings, erroneous social beliefs and improving self-awareness could provide key strategies to improve health policy which would reduce patient delay.
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Affiliation(s)
- Zohreh Khakbazan
- School of Nursing and Midwifery, Mashhad University of medical science, Mashhad, Iran
| | - Ali Taghipour
- Health Sciences Research Center, Department of Epidemiology and Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Robab Latifnejad Roudsari
- Evidence-Based Care Research Center, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Eesa Mohammadi
- Medical Sciences Faculty, Nursing Department, Tarbiat Modares University, Tehran, Iran
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Chatwin J, Povey A, Kennedy A, Frank T, Firth A, Booton R, Barber P, Sanders C. The mediation of social influences on smoking cessation and awareness of the early signs of lung cancer. BMC Public Health 2014; 14:1043. [PMID: 25293382 PMCID: PMC4209024 DOI: 10.1186/1471-2458-14-1043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 09/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whilst there has been no clear consensus on the potential for earlier diagnosis of lung cancer, recent research has suggested that the time between symptom onset and consultation can be long enough to plausibly affect prognosis. In this article, we present findings from a qualitative study involving in-depth interviews with patients who had been diagnosed with lung cancer (n = 11), and people who were at heightened risk of developing the disease (n = 14). METHODS A grounded theory methodology was drawn upon to conduct thematic and narrative based approaches to analysis. RESULTS The paper focuses on three main themes which emerged from the study: i) fatalism and resignation in pathways to help-seeking and the process of diagnosis; ii) Awareness of smoking risk and response to cessation information and advice. iii) The role of social and other networks on help-seeking. Key findings included: poor awareness among participants of the symptoms of lung cancer; ambivalence about the dangers of smoking; the perception of lung cancer as part of a homogenisation of multiple illnesses; close social networks as a key trigger in help-seeking. CONCLUSIONS We suggest that future smoking cessation and lung cancer awareness campaigns could usefully capitalise on the influence of close social networks, and would benefit from taking a 'softer' approach.
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Affiliation(s)
- John Chatwin
- School of Nursing, Midwifery, Social Work & Social Sciences, University of Salford UK, Allerton Building, Salford M6 6PU, UK.
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Brandner S, Müller-Nordhorn J, Stritter W, Fotopoulou C, Sehouli J, Holmberg C. Symptomization and triggering processes: Ovarian cancer patients' narratives on pre-diagnostic sensation experiences and the initiation of healthcare seeking. Soc Sci Med 2014; 119:123-30. [DOI: 10.1016/j.socscimed.2014.08.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 08/16/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
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Dobson CM, Russell AJ, Rubin GP. Patient delay in cancer diagnosis: what do we really mean and can we be more specific? BMC Health Serv Res 2014; 14:387. [PMID: 25217105 PMCID: PMC4175269 DOI: 10.1186/1472-6963-14-387] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 09/08/2014] [Indexed: 01/07/2023] Open
Abstract
Background Early diagnosis is a key focus of cancer control because of its association with survival. Delays in diagnosis can occur throughout the diagnostic pathway, within any one of its three component intervals: the patient interval, the primary care interval and the secondary care interval. Discussion A key focus for help-seeking research in patients with symptoms of cancer has been the concept of ‘delay’. The literature is plagued by definitional and semantic problems, which serve to hinder comparison between studies. Use of the word ‘delay’ has been criticised as judgemental and potentially stigmatising, because of its implications of intent. However, the suggested alternatives (time to presentation, appraisal interval, help-seeking interval and postponement of help-seeking) still fail to accurately define the concept in hand, and often conflate three quite separate ideas; that of an interval, that of an unacceptably long interval, and that of a specific event which caused delay in the diagnostic process. We discuss the need to disentangle current terminology and suggest the term ‘prolonged interval’ as a more appropriate alternative. Most studies treat the patient interval as a dichotomous variable, with cases beyond a specified time point classified as ‘delay’. However, there are inconsistencies in both where this line is drawn, ranging from one week to three months, and how, with some studies imposing seemingly arbitrary time points, others utilising the median as a divisive tool or exploring quartiles within their data. This not only makes comparison problematic, but, as many studies do not differentiate between cancer site, also imposes boundaries which are not necessarily site-relevant. We argue that analysis of the patient interval should be based on presenting symptom, as opposed to pathology, to better reflect the context of the help-seeking interval, and suggest how new definitional boundaries could be developed. Summary The word ‘delay’ is currently (conf)used to describe diverse conceptualisations of ‘delay’ and more mindful, and discerning language needs to be developed to enable a more sophisticated discussion. By stratifying help-seeking by presenting symptom(s), more accurate and informative analyses could be produced which, in turn, would result in more accurately targeted early diagnosis interventions.
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Christophe V, Leroy T, Seillier M, Duthilleul C, Julieron M, Clisant S, Foncel J, Vallet F, Lefebvre JL. Determinants of patient delay in doctor consultation in head and neck cancers (Protocol DEREDIA). BMJ Open 2014; 4:e005286. [PMID: 25063460 PMCID: PMC4120429 DOI: 10.1136/bmjopen-2014-005286] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Reducing the time between the onset of the first symptoms of cancer and the first consultation with a doctor (patient delay) is essential to improve the vital prognosis and quality of life of patients. Longer patient delay is linked to the already known sociodemographic, socioeconomic, socioeducational, sociocultural and socioprofessional factors. However, recent data suggest that some sociocognitive and emotional determinants may explain patient delay from a complementary point of view. The main objective of this study is to assess whether, in head and neck cancer, patient delay is linked to these sociocognitive and emotional factors, in addition to previously known factors. METHODS AND ANALYSIS We intend to include in this study 400 patients with a not yet treated head and neck cancer diagnosed in one of six health centres in the North of France region. The main evaluation criterion is 'patient delay'. Sociocognitive, emotional, medical, sociodemographic, socioeconomic, educational, professional and geographic factors will be assessed by means of (1) a case report form, (2) a questionnaire completed by the clinical research associate together with the patient, (3) a questionnaire completed by the patient and (4) a recorded semidirective interview of the patient by a psychologist (for 80 patients only). The collected data will be analysed to underline the differences between patients who consulted a doctor earlier versus those who consulted later. ETHICS The study has obtained all the relevant authorisations for the protection of patients enrolled in clinical trials (CCTIRS, CCP, CNIL), does not involve products mentioned in article L.5311-1 of the French Code of Public Health, and does not imply any changes in the medical care received by the patients. The study began in October 2012 and will end in June 2015. TRIAL REGISTRATION ID-RCB 2012-A00005-38.
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Affiliation(s)
- Véronique Christophe
- Lille 3 University—URECA EA1059, Villeneuve d'Ascq cedex, France
- U1086 INSERM “Cancers & Préventions”, Université de Caen Basse-Normandie, Avenue de la côte de Nacre, Caen Cedex 5, France
- SIRIC ONCOLille—Maison Régionale de la Recherche Clinique, Lille Cedex, France
| | - Tanguy Leroy
- Lille 3 University—URECA EA1059, Villeneuve d'Ascq cedex, France
- Aix-Marseille University—Public Health and Chronic Diseases, 3 SIRIC ONCOLille, EA 3279, Marseille cedex 05, France
| | - Mélanie Seillier
- Lille 3 University—URECA EA1059, Villeneuve d'Ascq cedex, France
- CERFEP, CARSAT Nord Pas de Calais Picardie, Villeneuve d'Ascq cedex, France
| | | | - Morbize Julieron
- Centre Oscar Lambret—Cervicofacial Oncology Department, Lille cedex, France
| | - Stéphanie Clisant
- Centre Oscar Lambret—Cervicofacial Oncology Department, Lille cedex, France
| | - Jérôme Foncel
- Lille 3 University—EQUIPPE EA 4018, Villeneuve d'Ascq cedex, France
| | - Fanny Vallet
- Lille 3 University—URECA EA1059, Villeneuve d'Ascq cedex, France
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Andersen RS, Risør MB. The importance of contextualization. Anthropological reflections on descriptive analysis, its limitations and implications. Anthropol Med 2014; 21:345-356. [PMID: 24484056 DOI: 10.1080/13648470.2013.876355] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This paper regards a concern for the quality of analyses made on the basis of qualitative interviews in some parts of qualitative health research. Starting with discussions departing in discussions on studies exploring 'patient delay' in healthcare seeking, it is argued that an implicit and simplified notion of causality impedes reflexivity on social context, on the nature of verbal statements and on the situatedness of the interview encounter. Further, the authors suggest that in order to improve the quality of descriptive analyses, it is pertinent to discuss the relationship between notions of causality and the need for contextualization in particular. This argument targets several disciplines taking a qualitative approach, including medical anthropology. In particular, researchers working in interdisciplinary fields face the demands of producing knowledge ready to implement, and such demands challenge basic notions of causality and explanatory power. In order to meet these, the authors suggest an analytic focus on process causality linked to contextualization.
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Affiliation(s)
- Rikke Sand Andersen
- a Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Faculty of Health & Department of Society and Culture - Anthropology, Faculty of Arts , Aarhus University , Aarhus , 8000 Denmark
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Bath-Hextall F, Jenkinson C, Kumar A, Leonardi-Bee J, Perkins W, Cox K, Glazebrook C. Longitudinal, mixed method study to look at the experiences and knowledge of non melanoma skin cancer from diagnosis to one year. BMC DERMATOLOGY 2013; 13:13. [PMID: 24164857 PMCID: PMC3819707 DOI: 10.1186/1471-5945-13-13] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 10/16/2013] [Indexed: 11/18/2022]
Abstract
Background Skin cancer is the most common type of cancer in humans and the incidence is increasing worldwide. Our objective was to understanding the needs, experiences and knowledge of individuals with Non Melanoma Skin Cancer (NMSC) from diagnosis up until one year. Methods Patients with NMSC completed questionnaires at diagnosis, treatment, 8 weeks post treatment and 12 months post diagnosis. Body image, psychological morbidity and Quality of Life (QOL) were assessed at each time point, with the exception of QOL that was not assessed at diagnosis. Knowledge of NMSC was assessed at baseline and 8 weeks. A sub-sample of participants was also interviewed to allow a more in-depth exploration of patients’ experiences. Results 76 participants completed the initial questionnaire, of which 15 were interviewed. Patients were anxious about a diagnosis of skin cancer, however they were no more depressed or anxious than the general population. QOL significantly improved from diagnosis to 8 weeks and from diagnosis to one year. Knowledge of NMSC was poor and did not improve after treatment. Hairdressers were highlighted as playing an important role in raising awareness and encouraging individuals to seek medical help. Most participants were aware of the need to check their skin for suspicious lesions but were not sure what to look for. At one year participants had forgotten their experience and were not overly concerned about skin cancer. Conclusion There is a need to raise awareness of the signs and symptoms of NMSC. Information on skin cancer needs to be tailored to the individual both at the start of treatment and during the follow up months, ensuring that participants’ needs and expectations are met. Targeting education at individuals in the community who regularly come into contact with skin should help in early identification of NMSC. This is important since skin cancer caught early is easily treatable and delay in presentation leads to larger and more complex lesions which impacts in terms of increased morbidity and increased health care costs.
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Affiliation(s)
- Fiona Bath-Hextall
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK.
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Pedersen AF, Hansen RP, Vedsted P. Patient delay in colorectal cancer patients: associations with rectal bleeding and thoughts about cancer. PLoS One 2013; 8:e69700. [PMID: 23894527 PMCID: PMC3718764 DOI: 10.1371/journal.pone.0069700] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 06/14/2013] [Indexed: 11/18/2022] Open
Abstract
Rectal bleeding is considered to be an alarm symptom of colorectal cancer. However, the symptom is seldom reported to the general practitioner and it is often assumed that patients assign the rectal bleeding to benign conditions. The aims of this questionnaire study were to examine whether rectal bleeding was associated with longer patient delays in colorectal cancer patients and whether rectal bleeding was associated with cancer worries. All incident colorectal cancer patients during a 1-year period in the County of Aarhus, Denmark, received a questionnaire. 136 colorectal cancer patients returned the questionnaire (response rate: 42%). Patient delay was assessed as the interval from first symptom to help-seeking and was reported by the patient. Patients with rectal bleeding (N = 81) reported longer patient intervals than patients without rectal bleeding when adjusting for confounders including other symptoms such as pain and changes in bowel habits (HR = 0.43; p = 0.004). Thoughts about cancer were not associated with the patient interval (HR = 1.05; p = 0.887), but more patients with rectal bleeding reported to have been wondering if their symptom(s) could be due to cancer than patients without rectal bleeding (chi2 = 15.29; p<0.001). Conclusively, rectal bleeding was associated with long patient delays in colorectal cancer patients although more patients with rectal bleeding reported to have been wondering if their symptom(s) could be due to cancer than patients without rectal bleeding. This suggests that assignment of symptoms to benign conditions is not the only explanation of long patient delays in this patient group and that barriers for timely help-seeking should be examined.
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Affiliation(s)
- Anette F Pedersen
- Research Unit for General Practice, The Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus University, Aarhus C, Denmark.
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Chatwin J, Sanders C. The influence of social factors on help-seeking for people with lung cancer. Eur J Cancer Care (Engl) 2013; 22:709-13. [PMID: 23731280 DOI: 10.1111/ecc.12078] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2013] [Indexed: 11/27/2022]
Abstract
While there has been no clear consensus on the potential for earlier diagnosis of lung cancer, recent research has suggested that the time between symptom onset and consultation can be long enough to plausibly affect prognosis. In this article, we present a review of the literature concerning help-seeking delays in lung cancer presentation, and more specifically, the role and influence that social factors may play in determining when and how people decide to seek medical help. We also consider how these factors contribute to patients' understanding of symptoms and illness indicators. We suggest that while there is research highlighting the importance of psychosocial influences on the general help-seeking behaviour of people with concerns about cancer, existing studies are mainly retrospective, and very little work has focused on identifying triggers and barriers specific to lung cancer. Further, we propose that while there have been a number of recent initiatives to raise awareness of the early signs of lung cancer, aimed at both patients and health professionals, little information provision has been targeted specifically at the formal and informal network level. This may be a useful avenue to pursue in future initiatives.
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Affiliation(s)
- J Chatwin
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
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Low EL, Simon AE, Lyons J, Romney-Alexander D, Waller J. What do British women know about cervical cancer symptoms and risk factors? Eur J Cancer 2012; 48:3001-8. [DOI: 10.1016/j.ejca.2012.05.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 05/02/2012] [Accepted: 05/03/2012] [Indexed: 10/28/2022]
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Smith SM, Murchie P, Devereux G, Johnston M, Lee AJ, Macleod U, Nicolson MC, Powell R, Ritchie LD, Wyke S, Campbell NC. Developing a complex intervention to reduce time to presentation with symptoms of lung cancer. Br J Gen Pract 2012; 62:e605-15. [PMID: 22947581 PMCID: PMC3426599 DOI: 10.3399/bjgp12x654579] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 04/03/2012] [Accepted: 04/18/2012] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Lung cancer is the commonest cause of cancer in Scotland and is usually advanced at diagnosis. Median time between symptom onset and consultation is 14 weeks, so an intervention to prompt earlier presentation could support earlier diagnosis and enable curative treatment in more cases. AIM To develop and optimise an intervention to reduce the time between onset and first consultation with symptoms that might indicate lung cancer. DESIGN AND SETTING Iterative development of complex healthcare intervention according to the MRC Framework conducted in Northeast Scotland. METHOD The study produced a complex intervention to promote early presentation of lung cancer symptoms. An expert multidisciplinary group developed the first draft of the intervention based on theory and existing evidence. This was refined following focus groups with health professionals and high-risk patients. RESULTS First draft intervention components included: information communicated persuasively, demonstrations of early consultation and its benefits, behaviour change techniques, and involvement of spouses/partners. Focus groups identified patient engagement, achieving behavioural change, and conflict at the patient-general practice interface as challenges and measures were incorporated to tackle these. Final intervention delivery included a detailed self-help manual and extended consultation with a trained research nurse at which specific action plans were devised. CONCLUSION The study has developed an intervention that appeals to patients and health professionals and has theoretical potential for benefit. Now it requires evaluation.
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Affiliation(s)
- Sarah M Smith
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen Health Centre, Aberdeen
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Forbat L, Place M, Kelly D, Hubbard G, Boyd K, Howie K, Leung HY. A cohort study reporting clinical risk factors and individual risk perceptions of prostate cancer: implications for PSA testing. BJU Int 2012; 111:389-95. [PMID: 23030810 DOI: 10.1111/j.1464-410x.2012.11316.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Prostate cancer has three known clinical risk factors: age, ethnicity and family history. Men's knowledge of prostate cancer is low. This study demonstrates that men rely on family and friends to learn about prostate cancer and help them interpret their risk. The findings suggest the need for tailored prostate cancer education, through social networks, to encourage risk-stratified PSA testing, which will lead to earlier diagnosis for those most at risk. OBJECTIVES To determine men's perceptions of their risk of developing prostate cancer. To consider the implications for PSA testing based on individual risk perceptions. PATIENTS AND METHODS The research adopted an embedded mixed-method design, using clinical records and a retrospective postal survey. Patients (N = 474) diagnosed with prostate cancer in a two-year period (2008-2009) in Greater Glasgow were identified from pathology records. In all, 458 men received a postal survey (16 deceased patients were excluded); 320 men responded (70%). RESULTS Analysis indicates that there is no association between known clinical risk factors and men's perceptions of their own risk. Older men did not display increased perceived risk. Men with a family history of prostate cancer (11%) had no increase in their own perception of risk. PSA tests are not requested by those who are at greater risk. The subsample of patients who had requested a test were no more likely to have a family history of prostate cancer. They were more likely, however, to perceive themselves to be at high risk, to have friends with prostate cancer, to be affluent and to have a low grade tumour. CONCLUSIONS GPs need to balance men's risk perceptions in discussions about known clinical risk factors. Men's knowledge of prostate cancer stems largely from interpersonal sources (such as friends/family). Social networks may consequently offer an additional opportunity to increase awareness of risk-stratified testing.
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Affiliation(s)
- Liz Forbat
- Cancer Care Research Centre, University of Stirling, Stirling FK9 4LA, UK.
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Scott SE, Walter FM, Webster A, Sutton S, Emery J. The model of pathways to treatment: conceptualization and integration with existing theory. Br J Health Psychol 2012; 18:45-65. [PMID: 22536840 DOI: 10.1111/j.2044-8287.2012.02077.x] [Citation(s) in RCA: 216] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Studying and understanding pathways to diagnosis and treatment is vital for the development of successful interventions to encourage early detection, presentation, and diagnosis. An existing framework posited to describe the decisional and behavioural processes that occur prior to treatment (Andersen et al.'s General Model of Total Patient Delay) does not appear to match the complex and dynamic nature of the pathways into and through the health care system or provide a clear framework for research. Therefore a revised descriptive framework, the Model of Pathways to Treatment, has been proposed. PURPOSE This paper presents the concepts and definitions of the Model of Pathways to Treatment and specifies how the model can encompass existing psychological theory, with particular focus on the Appraisal and Help-seeking intervals. The potential and direction for future work is also discussed. STATEMENT OF CONTRIBUTION WHAT IS ALREADY KNOWN ON THIS SUBJECT?: • The use of theory is often lacking in existing research into delays in presentation, diagnosis and treatment of illness. WHAT DOES THIS STUDY ADD?: • A detailed account of the concepts and definitions of a revised framework: the Model of Pathways to Treatment. • Specification of how the Model of Pathways to Treatment can encompass existing psychological theory such as the Common Sense Model of Illness Self-regulation and Social Cognitive Theory.
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Affiliation(s)
- S E Scott
- Unit of Social & Behavioural Sciences, Dental Institute, King's College London, UK.
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Solbjør M, Skolbekken JA, Sætnan AR, Hagen AI, Forsmo S. Could screening participation bias symptom interpretation? An interview study on women's interpretations of and responses to cancer symptoms between mammography screening rounds. BMJ Open 2012; 2:bmjopen-2012-001508. [PMID: 23148341 PMCID: PMC3532989 DOI: 10.1136/bmjopen-2012-001508] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To explore how women with negative mammography screening results, but who were later diagnosed with interval breast cancer, reacted when they observed breast symptoms that could indicate malignancy in-between screening rounds. DESIGN Semistructured individual interviews with women who have been diagnosed with breast cancer during mammography screening intervals. SETTING Two breast diagnostic units covering two counties in Norway. PARTICIPANTS 26 women diagnosed with interval breast cancer. RESULTS Women with a screening negative result react in two ways when experiencing a possible symptom of breast cancer. Among 24 women with a self-detected palpable lesion, 14 sought medical advice immediately. Their argument was to dispose of potential cancer as soon as possible. Ten women delayed seeking medical advice, explaining their delay as a result of practical difficulties such as holidays, uncertainty about the symptom, and previous experiences of healthcare services' ability to handle diffuse symptoms. Also, a recent negative mammography scan led some women to assume that the palpable lesion was benign and wait for the next screening round. CONCLUSIONS Participating in mammography screening may contribute to a postponed reaction to breast cancer symptoms, although most women acted rapidly when detecting a palpable breast lesion. Furthermore, screening participation does not necessarily increase awareness of breast cancer symptoms.
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Affiliation(s)
- Marit Solbjør
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medical Faculty, Trondheim, Norway
| | - John-Arne Skolbekken
- Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ann Rudinow Sætnan
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Irene Hagen
- Department of Breast and Endocrine Surgery, Trondheim University Hospital, Trondheim, Norway
| | - Siri Forsmo
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medical Faculty, Trondheim, Norway
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