1
|
Shrateh ON, Habib A, Jalamneh B, Omar BM, Naasan M. The level of medical students' knowledge regarding the prevention of cervical cancer. Ann Med Surg (Lond) 2024; 86:2591-2597. [PMID: 38694304 PMCID: PMC11060242 DOI: 10.1097/ms9.0000000000001935] [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: 02/09/2024] [Accepted: 02/29/2024] [Indexed: 05/04/2024] Open
Abstract
Background In Palestine, cervical cancer is the third most common gynaecological cancer, exhibiting higher mortality rates compared to regional counterparts. Late-stage diagnosis and limited awareness contribute to this disparity. This study aims to assess the awareness of Palestinian medical students regarding cervical cancer prevention. Methods A questionnaire-based survey involving 532 medical students from various Palestinian universities was conducted between October 2023 and December 2023. The survey encompassed closed-ended quantitative and demographic questions distributed through social media. Results The study was carried out on a group of 532 medical students (66.3% women and 33.6% men), (average age 21.7 years). Most students (77.7%) knew that the main risk factor for cervical cancer was human papillomavirus (HPV) infection. Participants doing the internship had the greatest knowledge, whereas students from the first year had the poorest knowledge about the main risk factors for cancer of the cervix. Only about half, 50.2% of all students, knew that in Palestine, there is no screening program. 84.4% of students correctly indicated that the cervical cancer screening test is a pap smear test. 41.4% of respondents knew that microscopic evaluation of the exfoliated cells from the vaginal part of the cervix is the screening test for cervical cancer which is used. Only about half of the students (45.1%) knew that there were no specific early symptoms of cervical cancer. Conclusions This study highlights the need for enhanced education, particularly regarding screening program awareness, among Palestinian medical students. Addressing these knowledge gaps is crucial for effective preventive strategies.
Collapse
Affiliation(s)
| | - Ashna Habib
- Dow University of Health Sciences, Mission Road, Karachi, Pakistan
| | - Basil Jalamneh
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | | | - Mashhour Naasan
- Department of Obstetrics and Gynecology, Al-Istishari Arab Hospital, Ramallah, Palestine
| |
Collapse
|
2
|
Mwaliko E, Itsura P, Keter A, De Bacquer D, Buziba N, Bastiaens H, Jackie A, Obala A, Naanyu V, Gichangi P, Temmerman M. Survival of cervical cancer patients at Moi teaching and Referral Hospital, Eldoret in western Kenya. BMC Cancer 2023; 23:1104. [PMID: 37957644 PMCID: PMC10644535 DOI: 10.1186/s12885-023-11506-w] [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: 10/12/2022] [Accepted: 10/10/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Cervical cancer is a major health burden and the second most common cancer after breast cancer among women in Kenya. Worldwide cervical cancer constitutes 3.1% of all cancer cases. Mortality rates are greatest among the low-income countries because of lack of awareness, screening and early-detection programs and adequate treatment facilities. The main aim was to estimate survival and determine survival predictors of women with cervical cancer and limited resources in western Kenya. METHODS Retrospective charts review of women diagnosed with cervical cancer and follow-up for two years from the date of the histologic diagnosis. The outcome of interest was death or survival at two years. Kaplan Meier estimates of survival, log-rank test and Cox proportional hazards regression were used in the survival analysis. RESULTS One hundred and sixty-two (162) participants were included in the review. The median duration was 0.8 (interquartile range (IQR) 0.3, 1.6) years. The mean age at diagnosis was 50.6 years (SD12.5). The mean parity was 5.9 (SD 2.6). Fifty percent (50%) did not have health insurance. Twenty six percent (26%) used hormonal contraceptives, 25.9% were HIV positive and 70% of them were on anti-retroviral treatment. The participants were followed up for 152.6 person years. Of the 162 women in the study, 70 (43.2%) died giving an overall incidence rate (IR) of 45.9 deaths per 100 person years of follow up. The hazard ratios were better for the patients who survived (0.44 vs 0.88, p-value < 0.001), those who had medical insurance (0.70 vs 0.48, p-value = 0.007) and those with early stage at diagnosis (0.88 vs 0.39, p-value < 0.001). Participants who were diagnosed at late stage of the disease according to the International Federation of Gynecology and Obstetrics staging for cervical cancer (FIGO stage 2B-4B) had more than eight times increased hazard of death compared to those who were diagnosed at early stage (1-2A): Hazard Ratio: 8.01 (95% CI 3.65, 17.57). Similarly, those who underwent surgical management had 84% reduced hazard of mortality compared to those who were referred for other modes of care: HR: 0.16 (95% CI: 0.07, 0.38). CONCLUSION Majority of the participants were diagnosed late after presenting with symptoms. The 1 and 2-year survival probability after diagnosis of cervical cancer was 57% AND 45% respectively. It is imperative that women present early since surgery gives better prognosis or better still screening of all women prioritized.
Collapse
Affiliation(s)
- E Mwaliko
- Department of Reproductive Health, School of Medicine, Moi University, Box 4606, Eldoret, 30100, Kenya.
| | - P Itsura
- Department of Reproductive Health, Gyn-Oncology Group, School of Medicine, Moi University, Box 4606, Eldoret, 30100, Kenya
| | - A Keter
- USAID AMPATH, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - N Buziba
- Department of Pathology, School of Medicine/Head, Registry, Moi, Eldoret Cancer , University, Box 4606, Eldoret, 30100, Kenya
| | - H Bastiaens
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Gouverneur Kinsbergen Centrum, Doornstraat 331, Wilrijk, 2610, Antwerp, Belgium
| | - A Jackie
- SBT Population Health AMPATH, P.O. Box 4606, Eldoret, Kenya
| | - A Obala
- Department of Microbiology, Health Sciences Project-VLIR-Moi University Project, P.O. Box 3900, Eldoret, 30100, Kenya
| | - V Naanyu
- DVC Academic Research & Extension, Technical University of Mombasa/Visiting Professor, Ghent University, Gent, Belgium
| | - P Gichangi
- Department of Sociology Psychology and Anthropology, School of Arts and Social Sciences, Moi University, P.O. Box 3900, Eldoret, 30100, Kenya
| | - M Temmerman
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
- Faculty of Heath Sciences, Department of Obstetrics and Gynaecology Aga Khan University, P O. Box 00100, Nairobi, Kenya
| |
Collapse
|
3
|
Vela‐Vallespín C, Medina‐Perucha L, Jacques‐Aviñó C, Codern‐Bové N, Harris M, Borras JM, Marzo‐Castillejo M. Women's experiences along the ovarian cancer diagnostic pathway in Catalonia: A qualitative study. Health Expect 2022; 26:476-487. [PMID: 36447409 PMCID: PMC9854297 DOI: 10.1111/hex.13681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Early detection of symptoms and prompt diagnosis of ovarian cancer are considered important avenues for improving patient experiences and outcomes. METHODS This qualitative study used a phenomenological approach to perform patient interviews, collecting individual accounts of the prediagnostic phase in women diagnosed and treated for ovarian cancer in 2016-2017. Purposive sampling was used to obtain a diverse sample of 24 participants, while thematic content analysis was used to extract themes and subthemes from interview data. RESULTS Three themes and nine subthemes were identified. The first theme was women's delay in recognizing symptoms and seeking care, with subthemes on the lack of knowledge about early signs of ovarian cancer, gender-related barriers and false reassurance from negative test results. A second theme was missed opportunities during healthcare encounters, due to misattribution of women's symptoms by their physicians, underestimation of symptom severity and need for mediation and inadequate tests and/or false negative results. Finally, interviews highlighted the use of resources and alternative healthcare pathways, including complementary/alternative medicines, access to private health care and women's capacity for action and decision-making (agency) about their health. CONCLUSION Delayed diagnosis of ovarian cancer is rooted in both individual factors (lack of health literacy, reluctance to seek care) and systemic issues (missed opportunities in healthcare encounters, access to timely specialist care). Further research is needed to investigate the extent to which traditional gender roles and socioeconomic inequalities condition women's ability to manage their own health and to interact with health professionals and the health system. PATIENT AND PUBLIC CONTRIBUTION In addition to the patient participation during the interviews, one author was a representative of a patient association.
Collapse
Affiliation(s)
- Carmen Vela‐Vallespín
- Primary Health Care Center Riu Nord i Riu Sud, Catalan Health InstitutBarcelonaSpain,Research Support Unit Metropolitana NordUniversity Institute for Primary Health Care Research (IDIAP) Jordi Gol, Catalan Health InstituteBarcelonaSpain
| | - Laura Medina‐Perucha
- Unitat Transversal de la RecercaFundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain,Unitat Transversal de la RecercaUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Constanza Jacques‐Aviñó
- Unitat Transversal de la RecercaFundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain,Unitat Transversal de la RecercaUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Núria Codern‐Bové
- Department of NursingEscola Universitària d'Infermeria i Teràpia Ocupacional de Terrassa, Universitat Autònoma BarcelonaBarcelonaSpain,Evaluation and Qualitative ResearchÀreaQBarcelonaSpain
| | | | - Josep M. Borras
- Department Clinical Sciences, Bellvitge Biomedical Research Institute (IDIBELL)University of BarcelonaBarcelonaSpain
| | - Mercè Marzo‐Castillejo
- Research Support Unit Metropolitana SudUniversity Institute for Primary Health Care Research IDIAPJordi GolBarcelonaSpain
| |
Collapse
|
4
|
Vejlgaard AS, Rasmussen S, Haastrup PF, Jarbøl DE, Balasubramaniam K. Is concern for gynaecological alarm symptoms associated with healthcare-seeking? A Danish population-based cross-sectional study. BMC Public Health 2022; 22:25. [PMID: 34991531 PMCID: PMC8739714 DOI: 10.1186/s12889-021-12389-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022] Open
Abstract
Background Diagnosing cancer at an early stage increases survival, and for most gynaecological cancers the diagnostic pathway is initiated, when women seek medical attention with symptoms. As many factors influence healthcare-seeking, knowledge about these factors is important. Concern can act as a barrier or a trigger for women experiencing gynaecological alarm symptoms. This study aimed to examine whether concern for the symptom or the current health was associated with healthcare-seeking among women with gynaecological alarm symptoms. Methods Some 100,000 randomly selected Danish citizens were invited to a national web-based survey. The questionnaire included items regarding symptom experiences, healthcare-seeking and concern for the experienced symptoms and current health. This study included 5019 women with self-reported gynaecological alarm symptoms (pelvic pain, pain during intercourse, bleeding during intercourse and postmenopausal bleeding). Concern was reported on a 5-point Likert scale from ‘not at all’ to ‘extremely’. Data were analysed using multivariate logistic regression models. Results Women who were ‘extremely’ concerned about a gynaecological alarm symptom had two to six times higher odds of reporting healthcare-seeking compared to women who were ‘not at all’ concerned. Symptom concern was associated with higher odds of healthcare-seeking for all four gynaecological alarm symptoms and the odds increased with increasing levels of concern. Additionally, concern for current health was associated with higher odds of healthcare-seeking. Concern for current health as expressed by others was positively associated with healthcare-seeking but had only minor influence on the association between concern for current health and healthcare-seeking. Conclusions Concern for a gynaecological alarm symptom and for current health was positively associated with healthcare-seeking. The results can be used for future informational health campaigns targeting individuals at risk of postponing warranted healthcare-seeking.
Collapse
Affiliation(s)
- Anja Schmidt Vejlgaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, DK5000, Odense C, Denmark
| | - Sanne Rasmussen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, DK5000, Odense C, Denmark
| | - Peter Fentz Haastrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, DK5000, Odense C, Denmark
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, DK5000, Odense C, Denmark
| | - Kirubakaran Balasubramaniam
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, DK5000, Odense C, Denmark.
| |
Collapse
|
5
|
Consultations for clinical features of possible cancer and associated urgent referrals before and during the COVID-19 pandemic: an observational cohort study from English primary care. Br J Cancer 2021; 126:948-956. [PMID: 34934176 PMCID: PMC8691390 DOI: 10.1038/s41416-021-01666-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/15/2021] [Accepted: 12/02/2021] [Indexed: 02/07/2023] Open
Abstract
Background It remains unclear to what extent reductions in urgent referrals for suspected cancer during the COVID-19 pandemic were the result of fewer patients attending primary care compared to GPs referring fewer patients. Methods Cohort study including electronic health records data from 8,192,069 patients from 663 English practices. Weekly consultation rates, cumulative consultations and referrals were calculated for 28 clinical features from the NICE suspected cancer guidelines. Clinical feature consultation rate ratios (CRR) and urgent referral rate ratios (RRR) compared time periods in 2020 with 2019. Findings Consultations for cancer clinical features decreased by 24.19% (95% CI: 24.04–24.34%) between 2019 and 2020, particularly in the 6–12 weeks following the first national lockdown. Urgent referrals for clinical features decreased by 10.47% (95% CI: 9.82–11.12%) between 2019 and 2020. Overall, once patients consulted with primary care, GPs urgently referred a similar or greater proportion of patients compared to previous years. Conclusion Due to the significant fall in patients consulting with clinical features of cancer there was a lower than expected number of urgent referrals in 2020. Sustained efforts should be made throughout the pandemic to encourage the public to consult their GP with cancer clinical features.
Collapse
|
6
|
Elshami M, Thalji M, Abukmail H, Al-Slaibi I, Alser M, Radaydeh A, Alfuqaha A, Khader S, Khatib L, Fannoun N, Ahmad B, Kassab L, Khrishi H, Elhussaini D, Abed N, Nammari A, Abdallah T, Alqudwa Z, Idais S, Tanbouz G, Hajajreh M, Selmiyh HA, Abo-Hajouj Z, Hebi H, Zamel M, Skaik RN, Hammoud L, Rjoub S, Ayesh H, Rjoub T, Zakout R, Alser A, Abu-El-Noor N, Bottcher B. Knowledge of cervical cancer risk factors among Palestinian women: a national cross-sectional study. BMC WOMENS HEALTH 2021; 21:385. [PMID: 34727914 PMCID: PMC8561913 DOI: 10.1186/s12905-021-01510-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/12/2021] [Indexed: 12/24/2022]
Abstract
Background High awareness of cervical cancer (CC) risk factors is important to decrease the morbidity and mortality associated with CC. This study aimed to assess the knowledge level of Palestinian women about CC risk factors and to determine the factors associated with good knowledge. Methods This was a national cross-sectional study. Adult women from hospitals, primary healthcare centers, and public spaces of 11 governorates in Palestine were recruited using a stratified convenience sampling. A translated-into-Arabic version of the validated CC awareness measure (CeCAM) was used to assess the knowledge about the 11 CC risk factors. For each correctly identified risk factor, the participant was given one point. The total score was calculated and was categorized into three categories: poor knowledge (0–3), fair knowledge (4–7), and good knowledge (8–11). Results A total of 7223 participants completed the Arabic CeCAM (response rate = 89.3%) and 7058 questionnaires were included in the final analysis: 2655 from the Gaza Strip and 4403 from the West Bank and Jerusalem. Participants recruited from the Gaza Strip were younger, getting lower monthly incomes, and with less chronic diseases than participants recruited from the West Bank and Jerusalem. The most frequently identified risk factor was ‘having a weakened immune system’ (n = 5458, 77.3%) followed by ‘infection with a sexually transmitted infection’ (n = 5388, 76.3%). The least identified risk factor was ‘having many children’ (n = 1597, 22.6%). Only 1670 women (23.7%) had good knowledge of CC risk factors. Women living in the Gaza Strip were more likely than women living in the West Bank and Jerusalem to have good knowledge (25.2% vs 22.7%). Completing a secondary or diploma degree, being employed, and having a monthly income of ≥ 1450 NIS (around $450) were all associated with lower likelihood of having good knowledge of CC risk factors. Conversely, knowing someone with cancer was associated with higher likelihood of having good knowledge. Conclusion The overall awareness of CC risk factors was low. There is a substantial need to establish educational programs to promote Palestinian women’s awareness of CC. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01510-2.
Collapse
Affiliation(s)
- Mohamedraed Elshami
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. .,Ministry of Health, Gaza, Palestine.
| | - Mariam Thalji
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Hanan Abukmail
- Ministry of Health, Gaza, Palestine.,Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | | | - Afnan Radaydeh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Alaa Alfuqaha
- Faculty of Graduate Studies, An-Najah National University, Nablus, Palestine
| | - Salma Khader
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Lana Khatib
- Faculty of Medicine, An-Najah National University, Nablus, Palestine
| | - Nour Fannoun
- Faculty of Pharmacy, Alazhar University of Gaza, Gaza, Palestine
| | - Bisan Ahmad
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | - Hiba Khrishi
- Faculty of Dentistry and Dental Surgery, Al-Quds University, Jerusalem, Palestine
| | - Deniz Elhussaini
- Faculty of Medicine, Alazhar University of Gaza, Gaza, Palestine
| | - Nour Abed
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Aya Nammari
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Zaina Alqudwa
- Faculty of Medicine, Alazhar University of Gaza, Gaza, Palestine
| | - Shahd Idais
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Ghaid Tanbouz
- Faculty of Dentistry and Dental Surgery, Al-Quds University, Jerusalem, Palestine
| | | | - Hala Abu Selmiyh
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | - Haya Hebi
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Manar Zamel
- Faculty of Medicine, An-Najah National University, Nablus, Palestine
| | | | - Lama Hammoud
- Faculty of Dentistry and Dental Surgery, Al-Quds University, Jerusalem, Palestine
| | - Saba Rjoub
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Hadeel Ayesh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Toqa Rjoub
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Rawan Zakout
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | | | - Bettina Bottcher
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| |
Collapse
|
7
|
Elshami M, Al-Slaibi I, Abukmail H, Alser M, Radaydeh A, Alfuqaha A, Thalji M, Khader S, Khatib L, Fannoun N, Ahmad B, Kassab L, Khrishi H, Elhussaini D, Abed N, Nammari A, Abdallah T, Alqudwa Z, Idais S, Tanbouz G, Hajajreh M, Selmiyh HA, Abo-Hajouj Z, Hebi H, Zamel M, Skaik R, Hammoud L, Rjoub S, Ayesh H, Rjoub T, Zakout R, Alser A, Abu-El-Noor N, Bottcher B. Knowledge of Palestinian women about cervical cancer warning signs: a national cross- sectional study. BMC Public Health 2021; 21:1779. [PMID: 34598690 PMCID: PMC8487127 DOI: 10.1186/s12889-021-11792-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background Timely presentation and diagnosis of cervical cancer (CC) are crucial to decrease its mortality especially in low- and middle-income countries like Palestine. This study aimed to evaluate the knowledge of Palestinian women about CC warning signs and determine the factors associated with good knowledge. Methods This was a national cross-sectional study conducted between July 2019 and March 2020 in Palestine. Stratified convenience sampling was used to recruit adult women from hospitals, primary healthcare centers, and public spaces of 11 governorates. A translated-into-Arabic version of the validated CC awareness measure (CeCAM) was used to assess women’s knowledge of 12 CC warning signs. Results Of 8086 approached, 7223 participants completed the CeCAM (response rate = 89.3%). A total of 7058 questionnaires were included in the analysis: 2655 from the Gaza Strip and 4403 from the West Bank and Jerusalem (WBJ). The median age [interquartile range] for all participants was 34.0 [24.0, 42.0] years. Participants recruited from the WBJ were older, getting higher monthly income, and having more chronic diseases than those recruited from the Gaza Strip. The most frequently identified warning sign was ‘vaginal bleeding after menopause’ (n = 5028, 71.2%) followed by ‘extreme generalized fatigue’ (n = 4601, 65.2%) and ‘unexplained weight loss’ (n = 4578, 64.9%). Only 1934 participants (27.4%) demonstrated good knowledge of CC warning signs. Participants from the Gaza Strip were slightly more likely than participants from the WBJ to have a good level of knowledge. Factors associated with having good knowledge included having a bachelor or postgraduate degree, being married, divorced, or widowed as well as knowing someone with cancer. Conclusion The overall awareness of CC warning signs was low. Educational interventions are needed to increase Palestinian women’s awareness of CC warning signs. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11792-8.
Collapse
Affiliation(s)
- Mohamedraed Elshami
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. .,Ministry of Health, Gaza, Palestine.
| | | | - Hanan Abukmail
- Ministry of Health, Gaza, Palestine.,Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | - Afnan Radaydeh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Alaa Alfuqaha
- Faculty of Graduate Studies, An-Najah National University, Nablus, Palestine
| | - Mariam Thalji
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Salma Khader
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Lana Khatib
- Faculty of Medicine, An-Najah National University, Nablus, Palestine
| | - Nour Fannoun
- Faculty of Pharmacy, Alazhar University of Gaza, Gaza, Palestine
| | - Bisan Ahmad
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | - Hiba Khrishi
- Faculty of Dentistry and Dental Surgery, Al-Quds University, Jerusalem, Palestine
| | - Deniz Elhussaini
- Faculty of Medicine, Alazhar University of Gaza, Gaza, Palestine
| | - Nour Abed
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Aya Nammari
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Zaina Alqudwa
- Faculty of Medicine, Alazhar University of Gaza, Gaza, Palestine
| | - Shahd Idais
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Ghaid Tanbouz
- Faculty of Dentistry and Dental Surgery, Al-Quds University, Jerusalem, Palestine
| | | | - Hala Abu Selmiyh
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | - Haya Hebi
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Manar Zamel
- Faculty of Medicine, An-Najah National University, Nablus, Palestine
| | - Refqa Skaik
- Faculty of Medicine, Alazhar University of Gaza, Gaza, Palestine
| | - Lama Hammoud
- Faculty of Dentistry and Dental Surgery, Al-Quds University, Jerusalem, Palestine
| | - Siba Rjoub
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Hadeel Ayesh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Toqa Rjoub
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Rawan Zakout
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | | | - Bettina Bottcher
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| |
Collapse
|
8
|
Quinn-Scoggins HD, Cannings-John R, Moriarty Y, Whitelock V, Whitaker KL, Grozeva D, Hughes J, Townson J, Osborne K, Goddard M, McCutchan GM, Waller J, Robling M, Hepburn J, Moore G, Gjini A, Brain K. Cancer symptom experience and help-seeking behaviour during the COVID-19 pandemic in the UK: a cross-sectional population survey. BMJ Open 2021; 11:e053095. [PMID: 34531224 PMCID: PMC8449845 DOI: 10.1136/bmjopen-2021-053095] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/11/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To understand self-reported potential cancer symptom help-seeking behaviours and attitudes during the first 6 months (March-August 2020) of the UK COVID-19 pandemic. DESIGN UK population-based survey conducted during August and September 2020. Correlates of help-seeking behaviour were modelled using logistic regression in participants reporting potential cancer symptoms during the previous 6 months. Qualitative telephone interviews with a purposeful subsample of participants, analysed thematically. SETTING Online UK wide survey. PARTICIPANTS 7543 adults recruited via Cancer Research UK online panel provider (Dynata) and HealthWise Wales (a national register of 'research ready' participants) supplemented with social media (Facebook and Twitter) recruitment. 30 participants were also interviewed. MAIN OUTCOME MEASURES Survey measures included experiences of 15 potential cancer symptoms, help-seeking behaviour, barriers and prompts to help-seeking. RESULTS Of 3025 (40.1%) participants who experienced a potential cancer symptom, 44.8% (1355/3025) had not contacted their general practitioner (GP). Odds of help-seeking were higher among participants with disability (adjusted OR (aOR)=1.38, 95% CI 1.11 to 1.71) and who experienced more symptoms (aOR=1.68, 95% CI 1.56 to 1.82), and lower among those who perceived COVID-19 as the cause of symptom(s) (aOR=0.36, 95% CI 0.25 to 0.52). Barriers included worries about wasting the doctor's time (1158/7543, 15.4%), putting strain on healthcare services (945, 12.6%) and not wanting to make a fuss (907, 12.0%). Interviewees reported reluctance to contact the GP due to concerns about COVID-19 and fear of attending hospitals, and described putting their health concerns on hold. CONCLUSIONS Many people avoided healthcare services despite experiencing potential cancer symptoms during the COVID-19 pandemic. Alongside current help-seeking campaigns, well-timed and appropriate nationally coordinated campaigns should signal that services are open safely for those with unusual or persistent symptoms. TRIAL REGISTRATION NUMBER ISRCTN17782018.
Collapse
Affiliation(s)
- Harriet D Quinn-Scoggins
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | | | | | | | | | | | - Julia Townson
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Mark Goddard
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Grace M McCutchan
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Michael Robling
- Centre for Trials Research, Cardiff University, Cardiff, UK
- DECIPHer (Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Julie Hepburn
- Public Involvement Community, Health and Care Research Wales Support Centre, Cardiff, UK
| | - Graham Moore
- DECIPHer (Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Ardiana Gjini
- Public Health Wales, Cardiff, UK
- Cardiff University, Cardiff, UK
| | - Kate Brain
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|
9
|
Hamilton AC, Donnelly DW, Loughrey MB, Turkington RC, Fox C, Fitzpatrick D, O'Neill CE, Gavin AT, Coleman HG. Inequalities in the decline and recovery of pathological cancer diagnoses during the first six months of the COVID-19 pandemic: a population-based study. Br J Cancer 2021; 125:798-805. [PMID: 34211120 PMCID: PMC8245662 DOI: 10.1038/s41416-021-01472-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/28/2021] [Accepted: 06/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The restructuring of healthcare systems to cope with the demands of the COVID-19 pandemic has led to a reduction in clinical services such as cancer screening and diagnostics. METHODS Data from the four Northern Ireland pathology laboratories were used to assess trends in pathological cancer diagnoses from 1st March to 12th September 2020 overall and by cancer site, sex and age. These trends were compared to the same timeframe from 2017 to 2019. RESULTS Between 1st March and 12th September 2020, there was a 23% reduction in cancer diagnoses compared to the same time period in the preceding 3 years. Although some recovery occurred in August and September 2020, this revealed inequalities across certain patient groups. Pathological diagnoses of lung, prostate and gynaecological malignancies remained well below pre-pandemic levels. Males and younger/middle-aged adults, particularly the 50-59-year-old patient group, also lagged behind other population demographic groups in terms of returning to expected numbers of pathological cancer diagnoses. CONCLUSIONS There is a critical need to protect cancer diagnostic services in the ongoing pandemic to facilitate timely investigation of potential cancer cases. Targeted public health campaigns may be needed to reduce emerging inequalities in cancer diagnoses as the COVID-19 pandemic continues.
Collapse
Affiliation(s)
- Ashleigh C Hamilton
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - David W Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
- Northern Ireland Cancer Registry, Belfast, Northern Ireland, UK
| | - Maurice B Loughrey
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, UK
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Richard C Turkington
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Colin Fox
- Northern Ireland Cancer Registry, Belfast, Northern Ireland, UK
| | | | - Ciaran E O'Neill
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
- Northern Ireland Cancer Registry, Belfast, Northern Ireland, UK
| | - Anna T Gavin
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
- Northern Ireland Cancer Registry, Belfast, Northern Ireland, UK
| | - Helen G Coleman
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
- Northern Ireland Cancer Registry, Belfast, Northern Ireland, UK
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, UK
| |
Collapse
|
10
|
Balasubramaniam K, Rasmussen S, Haastrup PF, Suadicani K, Søndergaard J, Jarbøl DE. Women's barriers for contacting general practice when experiencing gynecological cancer symptoms: a population-based study. BMC FAMILY PRACTICE 2021; 22:167. [PMID: 34399693 PMCID: PMC8369740 DOI: 10.1186/s12875-021-01518-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 07/31/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND A prerequisite for general practitioners (GPs) being able to refer patients with gynecological cancer alarm symptoms for further investigations is that individuals present the symptoms to the GP. Not all symptoms are presented to the GP, and knowledge of barriers for healthcare-seeking is sparse. The aim of this study was to analyze associations between age, socioeconomic status, and common barriers ("being too embarrassed", "being too busy", "worried about wasting the doctors time" and "worried what the GP might find") towards GP contact with gynecological alarm symptoms. METHODS Nationwide population-based study in Denmark based on a random sample of 51 090 women aged 20 years or older. A web-based questionnaire regarding experience of four predefined alarm symptoms of gynecological cancer, decisions about contact to GPs, and barriers towards GP contact was distributed. Information about socioeconomic status was collected from Statistics Denmark. RESULTS A total of 26 466 women (54.5%) completed the questionnaire. The proportion of women with no contact to the GP varied between 64.6% and 78.1% for postmenopausal bleeding and pain during intercourse, respectively. Between 32.3% (bleeding during intercourse) and 45.3% (postmenopausal bleeding) of the women reported no barriers for GP contact. The proportions of reported barriers ranged from 7.5% for being too embarrassed (pelvic pain) to 26.8% for being too busy (bleeding during intercourse). Women aged 40-59 years had lower odds of reporting "being too embarrassed" and "worried about wasting the GP´s time", while women aged 60 + years of age had lower odds of reporting "being too busy" compared to the youngest age group. Women in the highest income groups had lower odds of reporting "being too embarrassed" and "wasting the GP´s time" compared to those with a low income, while those with high educational level had lower odds of reporting "being too embarrassed" and "worried what the GP might find" compared to those with low educational level. CONCLUSIONS More than half of the respondents with no contact to the GP, reported one or more barriers towards GP contact. Lower age and socioeconomic status were significantly associated with higher odds of reporting barriers. As this may explain the differences in healthcare seeking behavior, healthcare planners, policy makers and clinicians should be aware of these findings.
Collapse
Affiliation(s)
- Kirubakaran Balasubramaniam
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark.
| | - Sanne Rasmussen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Peter Fentz Haastrup
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | | | - Jens Søndergaard
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Dorte Ejg Jarbøl
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark
| |
Collapse
|
11
|
Laake JP, Vulkan D, Quaife SL, Hamilton WT, Martins T, Waller J, Parmar D, Sasieni P, Duffy SW. Targeted encouragement of GP consultations for possible cancer symptoms: a randomised controlled trial. Br J Gen Pract 2021; 71:e339-e346. [PMID: 33875418 PMCID: PMC8087296 DOI: 10.3399/bjgp20x713489] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/05/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND For some common cancers, survival is lower in the UK than in comparable high-income countries. AIM To assess the effectiveness of a targeted postal intervention (to promote awareness of cancer symptoms and earlier help seeking) on patient consultation rates. DESIGN AND SETTING A two-arm randomised controlled trial was carried out on patients aged 50-84 years registered at 23 general practices in rural and urban areas of Greater London, Greater Manchester, and the North East of England. METHOD Patients who had not had a consultation at their general practice in the previous 12 months and had at least two other risk factors for late presentation with cancer were randomised to intervention and control arms. The intervention consisted of a posted letter and leaflet. Primary outcome was the number of consultations at the practice with patients randomised to each arm in the 6 months subsequent to posting the intervention. All patients with outcome data were included in the intention-to-treat analyses. RESULTS In total, 1513 patients were individually randomised to the intervention (n = 783) and control (n = 730) arms between Nov 2016 - May 2017; outcome data were available for 749 and 705 patients, respectively, with a statistically significantly higher rate of consultation in the intervention arm compared with the control arm: 436 versus 335 consultations (relative risk 1.40, 95% confidence interval = 1.11 to 1.77, P = 0.004). There was, however, no difference in the numbers of patients consulting. CONCLUSION Targeted interventions of this nature can change behaviour; there is a need to develop interventions that can be more effective at engaging patients with primary care. This study demonstrates that targeted interventions promoting both awareness of possible cancer symptoms and earlier health seeking, can change behaviour. There is a need to develop and test interventions that can be more effective at engaging the most at-risk patients.
Collapse
Affiliation(s)
- Jean-Pierre Laake
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; medical student, Warwick Medical School, University of Warwick, Coventry
| | - Daniel Vulkan
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London
| | - Samantha L Quaife
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; senior research fellow, Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London
| | | | | | - Jo Waller
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London; reader in cancer behavioural science, School of Cancer & Pharmaceutical Sciences, King's College London, London
| | - Dharmishta Parmar
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London
| | | | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London
| |
Collapse
|
12
|
Woods LM, Rachet B, Morris M, Bhaskaran K, Coleman MP. Are socio-economic inequalities in breast cancer survival explained by peri-diagnostic factors? BMC Cancer 2021; 21:485. [PMID: 33933034 PMCID: PMC8088027 DOI: 10.1186/s12885-021-08087-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/23/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patients living in more deprived localities have lower cancer survival in England, but the role of individual health status at diagnosis and the utilisation of primary health care in explaining these differentials has not been widely considered. We set out to evaluate whether pre-existing individual health status at diagnosis and primary care consultation history (peri-diagnostic factors) could explain socio-economic differentials in survival amongst women diagnosed with breast cancer. METHODS We conducted a retrospective cohort study of women aged 15-99 years diagnosed in England using linked routine data. Ecologically-derived measures of income deprivation were combined with individually-linked data from the English National Cancer Registry, Clinical Practice Research Datalink (CPRD) and Hospital Episodes Statistics (HES) databases. Smoking status, alcohol consumption, BMI, comorbidity, and consultation histories were derived for all patients. Time to breast surgery was derived for women diagnosed after 2005. We estimated net survival and modelled the excess hazard ratio of breast cancer death using flexible parametric models. We accounted for missing data using multiple imputation. RESULTS Net survival was lower amongst more deprived women, with a single unit increase in deprivation quintile inferring a 4.4% (95% CI 1.4-8.8) increase in excess mortality. Peri-diagnostic co-variables varied by deprivation but did not explain the differentials in multivariable analyses. CONCLUSIONS These data show that socio-economic inequalities in survival cannot be explained by consultation history or by pre-existing individual health status, as measured in primary care. Differentials in the effectiveness of treatment, beyond those measuring the inclusion of breast surgery and the timing of surgery, should be considered as part of the wider effort to reduce inequalities in premature mortality.
Collapse
Affiliation(s)
- Laura M Woods
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK.
| | - Bernard Rachet
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Melanie Morris
- Department of Health Services Research and Policy, Faculty of Public Health and Policy London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Krishnan Bhaskaran
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Michel P Coleman
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| |
Collapse
|
13
|
Carter P, Megnin-Viggars O, Rubin GJ. What Factors Influence Symptom Reporting and Access to Healthcare During an Emerging Infectious Disease Outbreak? A Rapid Review of the Evidence. Health Secur 2021; 19:353-363. [PMID: 33416425 PMCID: PMC8403196 DOI: 10.1089/hs.2020.0126] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
During any emerging infectious disease outbreak, people with symptoms of the illness are asked to report to a health service immediately to facilitate contact tracing. Several factors may influence a person's willingness to report symptoms and their ability to access healthcare services. Understanding these factors has become urgent during the COVID-19 pandemic. To determine which factors influence symptom reporting during an emerging infectious disease outbreak, we conducted a rapid review of the evidence. Studies included in the review were based on primary research, published in a peer-reviewed journal, written in English, included factors associated with symptom reporting or accessing healthcare, and were related to a major public health incident involving an infectious disease outbreak. Five themes were identified as facilitators of symptom reporting or accessing healthcare: accurate and informative communication about the disease and the need to seek help, symptom severity, concern about disease exposure, ease of access to healthcare facilities, and relationship with the healthcare provider. Seven themes were identified as barriers to symptom reporting or accessing healthcare: lack of knowledge of the disease and its treatment, fear of the disease and fear of subsequent treatments or requirements, stigmatization attached to having a disease, invasion of privacy, low concern about symptoms, economic consequences of disease diagnosis, and challenges related to attending a healthcare facility. For contract tracing services to be effective, members of the public need to have the capability, opportunity, and motivation to use them. The themes identified should be used to evaluate information provided to the public to ensure as many people as possible with relevant symptoms report them to a healthcare provider.
Collapse
Affiliation(s)
- Patrice Carter
- Patrice Carter, PhD, and Odette Megnin-Viggars, PhD, are Senior Systematic Reviewers; both at the Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK. Patrice Carter is also a Senior Systematic Reviewer, Health Economics & Outcomes Research Ltd, Cardiff, UK. G. James Rubin, PhD, is Assistant Director, Health Protection Unit in Emergency Preparedness and Response, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Odette Megnin-Viggars
- Patrice Carter, PhD, and Odette Megnin-Viggars, PhD, are Senior Systematic Reviewers; both at the Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK. Patrice Carter is also a Senior Systematic Reviewer, Health Economics & Outcomes Research Ltd, Cardiff, UK. G. James Rubin, PhD, is Assistant Director, Health Protection Unit in Emergency Preparedness and Response, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - G James Rubin
- Patrice Carter, PhD, and Odette Megnin-Viggars, PhD, are Senior Systematic Reviewers; both at the Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK. Patrice Carter is also a Senior Systematic Reviewer, Health Economics & Outcomes Research Ltd, Cardiff, UK. G. James Rubin, PhD, is Assistant Director, Health Protection Unit in Emergency Preparedness and Response, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| |
Collapse
|
14
|
Symptom Disclosure Process Among Iranian Women With Self-discovered Breast Cancer. Cancer Nurs 2020; 45:21-30. [PMID: 32657898 DOI: 10.1097/ncc.0000000000000861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Breast cancer is the most common malignancy among Iranian women. Symptom disclosure plays an important role in help-seeking behavior among women with self-discovered breast cancer. OBJECTIVE The aim of this study was to explain how symptoms are disclosed by Iranian women. METHODS This study was conducted based on the grounded theory qualitative approach. Twenty-two Iranian women with breast cancer, who discovered the symptoms themselves and were referred to 2 teaching hospitals in Tehran and Qazvin, were included via purposive and theoretical sampling. The data were collected through semistructured interviews and were analyzed based on the Corbin and Strauss approach. RESULTS The process of symptom disclosure had 5 stages including identifying the symptoms, evaluating and interpreting the symptoms, weighing the disclosure conditions, selecting the disclosure audience, and disclosing. The perceived threat was identified as the core category. On the basis of the level of threat perception and the seriousness of the symptoms, the 3 patterns of immediate disclosure, delayed disclosure, and nondisclosure were recognized. CONCLUSION Perceived threat is the main motivator for rapid disclosure in Iranian women with potential breast cancer symptoms and leads to a better follow-up of the symptoms. Therefore, increasing women's awareness about breast cancer symptoms, treatments, and non-follow-up consequences leads to a better perception of the threat level. IMPLICATIONS FOR PRACTICE According to these findings, it is very important to increase Iranian women's awareness about the symptoms of breast cancer (especially the nonspecific ones). For this purpose, it is necessary to design educational interventions.
Collapse
|
15
|
Alshammari SA, Alenazi HA, Alshammari HS. Knowledge, attitude and practice towards early screening of colorectal cancer in Riyadh. J Family Med Prim Care 2020; 9:2273-2280. [PMID: 32754487 PMCID: PMC7380819 DOI: 10.4103/jfmpc.jfmpc_290_20] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/14/2020] [Accepted: 04/07/2020] [Indexed: 12/30/2022] Open
Abstract
Background and Aims: Colorectal cancer (CRC) is a common cause of mortality worldwide. It is preventable, treatable when detected early. The aim of this study is to assess knowledge, attitude and practice (KAP) of the participants toward CRC and its early screening, and identify the sources of information on the subjects. Methods: We conducted a cross-sectional study on the people 40y old and above at the primary care clinics at King Saud university medical city (KSUMC) in Riyadh. The estimated sample size was 245 subjects whom we requested to complete a self-administered Arabic questionnaire, which consisted of three parts. These were: 1. Demographic data, 2. KAP toward CRC, its early detection. 3 sources of information of the public about colorectal cancer. Results: A total of 231 subjects participated; (54.5%) were male (mean age = 50.7 ± 9.8). About 47% of the participants heard about cancer screening, and 45% knew that colonoscopy is used for such purposes. Another 24.2% were aware that occult blood in the stool test is a method of early detection of colon cancer. About 40% to 50% of the subjects were knowledgeable about hazardous factors and cautioning symptoms for CRC. Only 6.5% of the subjects did an early screening for CRC, but 82.9% would do it if their doctor advised them to do so. Conclusion: The participant's knowledge and early checkups of CRC are inadequate. They would undergo early screening if their doctors advised them to do so. It is time to develop a national policy for CRC screening involving primary care doctors and utilizing social media to improve people's information.
Collapse
Affiliation(s)
- Sulaiman A Alshammari
- Health Promotion and Health Education Research chair, Department of Family and Community Medicine, College of Medicine, King Saud University, Ad Diriyah, Saudi Arabia
| | | | | |
Collapse
|
16
|
Smith SM, Whitaker KL, Cardy AH, Elliott AM, Hannaford PC, Murchie P. Validation of self-reported help-seeking, and measurement of the patient interval, for cancer symptoms: an observational study to inform methodological challenges in symptomatic presentation research. Fam Pract 2020; 37:91-97. [PMID: 31529030 DOI: 10.1093/fampra/cmz047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To improve earlier presentation with potential symptoms of cancer, accurate data are needed on how people respond to these symptoms. It is currently unclear how self-reported medical help-seeking for symptoms associated with cancer by people from the community correspond to what is recorded in their general practice records, or how well the patient interval (time from symptom onset to first presentation to a health-professional) can be estimated from patient records. METHOD Data from two studies that reviewed general practice electronic records of residents in Scotland, (i) the 'Useful Study': respondents to a general population survey who reported experiencing symptoms potentially associated with one of four common cancers (breast, colorectal, lung and upper gastro-intestinal) and (ii) the 'Detect Cancer Early' programme: cancer patients with one of the same four cancers. Survey respondents' self-reported help-seeking (yes/no) was corroborated; Cohen's Kappa assessed level of agreement. Combined data on the patient interval were evaluated using descriptive analysis. RESULTS 'Useful Study' respondents' self-report of help-seeking showed exact correspondence with general practice electronic records in 72% of cases (n = 136, kappa 0.453, moderate agreement). Between both studies, 1269 patient records from 35 general practices were reviewed. The patient interval could not be determined in 44% (n = 809) of symptoms presented by these individuals. CONCLUSIONS Patient self-report of help-seeking for symptoms potentially associated with cancer offer a reasonably accurate method to research responses to these symptoms. Incomplete patient interval data suggest routine general practice records are unreliable for measuring this important part of the patient's symptom journey.
Collapse
Affiliation(s)
- Sarah M Smith
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen
| | | | - Amanda H Cardy
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen
| | | | - Philip C Hannaford
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen
| | - Peter Murchie
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen
| |
Collapse
|
17
|
Hannaford PC, Thornton AJ, Murchie P, Whitaker KL, Adam R, Elliott AM. Patterns of symptoms possibly indicative of cancer and associated help-seeking behaviour in a large sample of United Kingdom residents-The USEFUL study. PLoS One 2020; 15:e0228033. [PMID: 31978177 PMCID: PMC6980617 DOI: 10.1371/journal.pone.0228033] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/06/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Cancer awareness campaigns aim to increase awareness of the potential seriousness of signs and symptoms of cancer, and encourage their timely presentation to healthcare services. Enhanced understanding of the prevalence of symptoms possibly indicative of cancer in different population subgroups, and associated general practitioner (GP) help-seeking behaviour, will help to target cancer awareness campaigns more effectively. AIM To determine: i) the prevalence of 21 symptoms possibly indicative of breast, colorectal, lung or upper gastrointestinal cancer in the United Kingdom (UK), including six 'red flag' symptoms; ii) whether the prevalence varies among population subgroups; iii) the proportion of symptoms self-reported as presented to GPs; iv) whether GP help-seeking behaviour varies within population subgroups. METHODS Self-completed questionnaire about experience of, and response to, 25 symptoms (including 21 possibly indicative of the four cancers of interest) in the previous month and year; sent to 50,000 adults aged 50 years or more and registered with 21 general practices in Staffordshire, England or across Scotland. RESULTS Completed questionnaires were received from 16,778 respondents (corrected response rate 34.2%). Almost half (45.8%) of respondents had experienced at least one symptom possibly indicative of cancer in the last month, and 58.5% in the last year. The prevalence of individual symptoms varied widely (e.g. in the last year between near zero% (vomiting up blood) and 15.0% (tired all the time). Red flag symptoms were uncommon. Female gender, inability to work because of illness, smoking, a history of a specified medical diagnosis, low social support and lower household income were consistently associated with experiencing at least one symptom possibly indicative of cancer in both the last month and year. The proportion of people who had contacted their GP about a symptom experienced in the last month varied between 8.1% (persistent cough) and 39.9% (unexplained weight loss); in the last year between 32.8% (hoarseness) and 85.4% (lump in breast). Nearly half of respondents experiencing at least one red flag symptom in the last year did not contact their GP about it. Females, those aged 80+ years, those unable to work because of illness, ex-smokers and those previously diagnosed with a specified condition were more likely to report a symptom possibly indicative of cancer to their GP; and those on high household income less likely. CONCLUSION Symptoms possibly indicative of cancer are common among adults aged 50+ years in the UK, although they are not evenly distributed. Help-seeking responses to different symptoms also vary. Our results suggest important opportunities to provide more nuanced messaging and targeting of symptom-based cancer awareness campaigns.
Collapse
Affiliation(s)
- Philip C. Hannaford
- Centre for Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Alison J. Thornton
- Centre for Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Peter Murchie
- Centre for Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Katriina L. Whitaker
- School of Health Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Rosalind Adam
- Centre for Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | | |
Collapse
|
18
|
Koo MM, Swann R, McPhail S, Abel GA, Elliss-Brookes L, Rubin GP, Lyratzopoulos G. Presenting symptoms of cancer and stage at diagnosis: evidence from a cross-sectional, population-based study. Lancet Oncol 2020; 21:73-79. [PMID: 31704137 PMCID: PMC6941215 DOI: 10.1016/s1470-2045(19)30595-9] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Early diagnosis interventions such as symptom awareness campaigns increasingly form part of global cancer control strategies. However, these strategies will have little impact in improving cancer outcomes if the targeted symptoms represent advanced stage of disease. Therefore, we aimed to examine associations between common presenting symptoms of cancer and stage at diagnosis. METHODS In this cross-sectional study, we analysed population-level data from the English National Cancer Diagnosis Audit 2014 for patients aged 25 years and older with one of 12 types of solid tumours (bladder, breast, colon, endometrial, laryngeal, lung, melanoma, oral or oropharyngeal, ovarian, prostate, rectal, and renal cancer). We considered 20 common presenting symptoms and examined their associations with stage at diagnosis (TNM stage IV vs stage I-III) using logistic regression. For each symptom, we estimated these associations when reported as a single presenting symptom and when reported together with other symptoms. FINDINGS We analysed data for 7997 patients. The proportion of patients diagnosed with stage IV cancer varied substantially by presenting symptom, from 1% (95% CI 1-3; eight of 584 patients) for abnormal mole to 80% (71-87; 84 of 105 patients) for neck lump. Three of the examined symptoms (neck lump, chest pain, and back pain) were consistently associated with increased odds of stage IV cancer, whether reported alone or with other symptoms, whereas the opposite was true for abnormal mole, breast lump, postmenopausal bleeding, and rectal bleeding. For 13 of the 20 symptoms (abnormal mole, breast lump, post-menopausal bleeding, rectal bleeding, lower urinary tract symptoms, haematuria, change in bowel habit, hoarseness, fatigue, abdominal pain, lower abdominal pain, weight loss, and the "any other symptom" category), more than 50% of patients were diagnosed at stages other than stage IV; for 19 of the 20 studied symptoms (all except for neck lump), more than a third of patients were diagnosed at stages other than stage IV. INTERPRETATION Despite specific presenting symptoms being more strongly associated with advanced stage at diagnosis than others, for most symptoms, large proportions of patients are diagnosed at stages other than stage IV. These findings provide support for early diagnosis interventions targeting common cancer symptoms, countering concerns that they might be simply expediting the detection of advanced stage disease. FUNDING UK Department of Health's Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis; and Cancer Research UK.
Collapse
Affiliation(s)
- Minjoung Monica Koo
- University College London, London, UK; National Cancer Registration and Analysis Service, Public Health England, London, UK.
| | - Ruth Swann
- National Cancer Registration and Analysis Service, Public Health England, London, UK; Cancer Research UK, London, UK
| | - Sean McPhail
- University College London, London, UK; National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Gary A Abel
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Lucy Elliss-Brookes
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Greg P Rubin
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Georgios Lyratzopoulos
- University College London, London, UK; National Cancer Registration and Analysis Service, Public Health England, London, UK
| |
Collapse
|
19
|
Momeni M, Rafii F. Help-seeking behaviour for cancer symptoms: an evolutionary concept analysis. Scand J Caring Sci 2019; 34:807-817. [PMID: 31749236 DOI: 10.1111/scs.12788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/09/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cancer survival largely depends on its early diagnosis. Therefore, assessing help-seeking behaviours among people with potential symptoms of cancer is essential. AIM This study aimed to analyse the concept of help-seeking behaviour for cancer symptoms. METHODS This concept analysis was conducted using Rodger's evolutionary method. An online literature search was conducted in the PubMed, Scopus and Cochrane databases to find relevant articles published from 2000 to 2017 in English peer-reviewed journals. In total, ninety articles were included in the study. Through thematic analysis, the data were analysed for the definitions, attributes, antecedents and consequences of the concept of help-seeking behaviour for cancer symptoms. RESULTS The concept of help-seeking behaviour for cancer symptoms includes a chain of behaviours and is defined as the process of informed decision-making for seeking medical help and using healthcare services after the detection of the first potential cancer symptoms. The attributes of the concept of help-seeking behaviour for cancer symptoms include process, problem-centeredness, intentional action and interpersonal interaction. Antecedents of the concept of help-seeking behaviour for cancer symptoms were broadly categorised as its facilitators and barriers, among which old age, young age, marriage, low education level, positive family history of cancer, fear over cancer, low perceived threat, symptom disclosure to significant others are both facilitator and barrier. The consequences of the concept of help-seeking behaviour for cancer symptoms were also broadly categorised in the two main categories of positive consequences and adverse consequences. CONCLUSIONS Help-seeking behaviour is a multidimensional time-dependent and context-bound concept which is usually defined based on the concept of time in order to facilitate its measurement. It is generally used for assessing patients' delay in seeking medical help. The findings of this study provide better understanding about the concept of help-seeking behaviour for cancer symptoms and its implications for research and practice.
Collapse
Affiliation(s)
- Maryam Momeni
- Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Forough Rafii
- Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Saab MM, Landers M, Cooke E, Murphy D, Davoren M, Hegarty J. Enhancing Men's Awareness of Testicular Disorders Using a Virtual Reality Intervention: A Pre-Post Pilot Study. Nurs Res 2019; 67:349-358. [PMID: 30059354 DOI: 10.1097/nnr.0000000000000303] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The incidence of benign and malignant testicular disorders is on the rise. Three literature reviews and one qualitative study found that men's awareness of testicular disorders was lacking, and their intentions to seek help for symptoms of testicular disease were low. OBJECTIVES The aim of the study was to enhance men's awareness of testicular disorders, help-seeking intentions for testicular symptoms, and intention and behavior to feel their testes. METHODS Men aged 18-50 years were recruited from a university and asked to engage in a three-level, educational, virtual reality experience. The Medical Research Council framework guided the development and pilot testing of the intervention. Knowledge, awareness, perceived risk, implementation intentions, help-seeking intentions, and behaviors were measured at pretest (T0), immediately posttest (T1), and 1 month posttest (T2). RESULTS Data were available from 49 participants. In comparison to T0, a significant increase in knowledge (mean difference [MD] = 3.5, 95% CI [2.8, 4.26]); testicular awareness (MD = 0.2, 95% CI [0.01, 0.41]); implementation intentions (MD = 0.6, 95% CI [0.33, 0.90]); and help-seeking intentions for testicular swelling (MD = 0.3, 95% CI [0.12, 0.51]), lumpiness (MD = 0.3, 95% CI [0.08, 0.46]), and pain (MD = 0.6, 95% CI [0.25, 1.01]) was noted at T1. This increase was maintained at T2. Participants who expressed an intention to feel their testes at T0 were more likely to report performing this behavior at T2. DISCUSSION The intervention succeeded in promoting knowledge, testicular awareness, implementation intentions, help-seeking intentions, and behaviors. A randomized controlled trial of the Enhancing Men's Awareness of Testicular Disorders intervention with a larger sample size is warranted.
Collapse
Affiliation(s)
- Mohamad M Saab
- Mohamad M. Saab, PhD, MSc, BSc, RGN, is Lecturer, Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland. Margaret Landers, PhD, MSc, BSc, RNT, RGN, is Lecturer, Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland. Josephine Hegarty, PhD, MSc, BSc, RNT, RGN, is Professor, at Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland. Eoghan Cooke, MSc, BA, is Interactive Media Professional, Department of Computer Science, University College Cork, Ireland. David Murphy, BMus, is Lecturer, Department of Computer Science, University College Cork, Ireland. Martin Davoren, PhD, MPH, BSc, is Adjunct Lecturer, School of Public Health, University College Cork, and Chief Executive Officer at The Sexual Health Centre, Cork, Ireland
| | | | | | | | | | | |
Collapse
|
22
|
Jarbøl DE, Rasmussen S, Svendsen RP, Balasubramaniam K, Haastrup PF, Petersen MS, Fallah M, Elnegaard S. Barriers to contacting general practice with alarm symptoms of colorectal cancer: a population-based study. Fam Pract 2018; 35:399-405. [PMID: 29240888 DOI: 10.1093/fampra/cmx117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A prerequisite for general practitioners (GPs) being able to refer patients with cancer alarm symptoms for further investigations is that individuals present to the GP. Knowledge of barriers to help-seeking is, however, sparse. Objectives. The aim of this study was to analyse associations between the experience of recent-onset alarm symptom of colorectal cancer and four different barriers towards GP contact. METHODS A nationwide web-based cohort survey was conducted in 100000 individuals aged 20 years or above, randomly selected from the Danish Civil Registration System. Items regarding experience of four predefined alarm symptoms of colorectal cancer (rectal bleeding, abdominal pain, change in stool texture and change in stool frequency), decisions about contact to GPs and barriers towards GP contact were included. RESULTS A total of 37455 respondents over 40 years (51.8%) completed the questionnaire. The proportion of individuals with no contact to the GP varied between 69.8% and 79.8% for rectal bleeding and change in stool frequency, respectively. The most widely reported barriers were being worried about wasting the doctor's time and being too busy to make time to visit the doctor. Men with rectal bleeding significantly more often reported being worried about what the doctor might find. The proportion of individuals who reported barriers was, in general, higher among the youngest age group. CONCLUSION Barriers to contacting the GP were frequent when experiencing alarm symptoms of colorectal cancer. Reporting the different barriers was significantly associated with gender and age.
Collapse
Affiliation(s)
- Dorte E Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sanne Rasmussen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Rikke P Svendsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kirubakaran Balasubramaniam
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Peter F Haastrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | | | - Sandra Elnegaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
23
|
Davies H, Marcu A, Vedsted P, Whitaker KL. Is lower symptom recognition associated with socioeconomic inequalities in help-seeking for potential breast cancer symptoms? Psychooncology 2018; 27:626-632. [PMID: 28940942 DOI: 10.1002/pon.4557] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/16/2017] [Accepted: 09/13/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Socioeconomic inequalities in recognising signs and symptoms of cancer may result in inequalities in timely help-seeking and subsequent prognosis of breast cancer. We explored the mediating role of symptom attribution and concern on the relationship between level of education and help-seeking for potential breast cancer symptoms. METHODS Women aged ≥47 years (n = 961) were purposively recruited (by education) to complete an online vignette-based survey that included nipple rash and axillary lump (in separate vignettes) as potential symptoms of breast cancer. Women completed questions relating to medical help-seeking (yes/no), cancer attribution, symptom concern, cancer avoidance, family history, and demographics. RESULTS Women with low education and mid education attributed nipple rash less often to cancer (26% and 27% mentioned cancer) than women with a degree or higher (40%). However, women with a degree or higher (63%) or mid education (64%) were less likely to anticipate seeking help for the nipple rash than women with no formal qualifications (73%). This association was statistically significant in the 60- to 69-year-old age group. There was no significant association between education and help-seeking for axillary lump. Mediation analysis adjusting for potential confounders confirmed that the association between education and help-seeking for nipple rash was fully mediated by symptom concern. CONCLUSIONS Socioeconomic inequalities in stage at diagnosis and survival of breast cancer may not always be explained by lower likelihood of suspecting cancer and subsequent impact on help-seeking. Reducing inequalities in stage at diagnosis will involve understanding a broader range of bio-psycho-social factors (eg, comorbidities and healthcare system factors).
Collapse
Affiliation(s)
- Hilary Davies
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Afrodita Marcu
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Peter Vedsted
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Faculty of Health, Aarhus University, Aarhus, Denmark
| | | |
Collapse
|
24
|
Not visiting the GP and the risk of cancer: what are the possible implications for research, policy and practice? Int J Cancer 2017; 141:2378. [PMID: 28960287 DOI: 10.1002/ijc.31033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
25
|
Elnegaard S, Pedersen AF, Sand Andersen R, Christensen RDP, Jarbøl DE. What triggers healthcare-seeking behaviour when experiencing a symptom? Results from a population-based survey. BJGP Open 2017; 1:bjgpopen17X100761. [PMID: 30564656 PMCID: PMC6169954 DOI: 10.3399/bjgpopen17x100761] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 11/23/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The decision process of whether or not to contact the GP is influenced by different factors which have not all been well examined. AIM The aim of this study was to analyse whether contact to the GP is associated with concern about the symptom, influence on daily activities and symptom burden, such as the total number of symptoms experienced by each person in a general population. DESIGN & SETTING This Danish nationwide cross-sectional study comprises a random sample of 100 000 people, representative of the adult Danish population ≥20 years. METHOD Baseline data were collected in a web-based survey conducted from June to December 2012. RESULTS In total 49 706 (52.5%) individuals answered the questionnaire; 45 483 (91.5%) individuals experienced at least one of 44 predefined symptoms during the 4 weeks preceding the completion of the questionnaire. They reported 268 772 symptom experiences of which 58 370 symptoms (21.7%) resulted in contact with a GP. A high level of concern and influence on daily activities was associated with significantly higher odds for GP contact. A high burden of symptoms was associated with lower odds of contact with the GP. CONCLUSION Approximately every fifth symptom reported by individuals from the general population leads to GP contact. Influence on daily activities, burden of symptoms, and concern about the symptom were significant factors associated with the decision of whether to contact the GP. No overall association between sex and GP contact was observed.
Collapse
Affiliation(s)
- Sandra Elnegaard
- PhD Student, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anette Fischer Pedersen
- Associate Professor, MSc, Research Unit for General Practice, Danish Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Rikke Sand Andersen
- Associate Professor, Anthropologist, Research Unit for General Practice, Danish Research Centre for Cancer Diagnosis (CaP), Department of Public Health, Aarhus University, Aarhus, Denmark
| | - René de-Pont Christensen
- Biostatistician, Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Dorte Ejg Jarbøl
- Associate Professor, Senior Researcher, GP, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
26
|
Marcu A, Black G, Vedsted P, Lyratzopoulos G, Whitaker KL. Educational differences in responses to breast cancer symptoms: A qualitative comparative study. Br J Health Psychol 2017; 22:26-41. [PMID: 27680898 DOI: 10.1111/bjhp.12215] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 08/12/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Advanced stage at diagnosis for breast cancer is associated with lower socio-economic status (SES). We explored what factors in the patient interval (time from noticing a bodily change to first consultation with a health care professional) may contribute to this inequality. DESIGN Qualitative comparative study. METHODS Semi-structured interviews with a sample of women (≥47 years) from higher (n = 15) and lower (n = 15) educational backgrounds, who had experienced at least one potential breast cancer symptom. Half the participants (n = 15) had sought medical help, half had not (n = 15). Without making breast cancer explicit, we elicited women's sense-making around their symptoms and help-seeking decisions. RESULTS Containment of symptoms and confidence in acting upon symptoms emerged as two broad themes that differentiated lower and higher educational groups. Women from lower educational backgrounds tended to attribute their breast symptoms to trivial factors and were reticent in using the word 'cancer'. Despite 'knowing' that symptoms could be related to cancer, women with lower education invoked lack of medical knowledge - 'I am not a doctor' - to express uncertainty about interpreting symptoms and accessing help. Women with higher education were confident about interpreting symptoms, seeking information online, and seeking medical help. CONCLUSIONS Our findings suggest that knowledge of breast cancer alone may not explain socio-economic differences in how women respond to breast cancer symptoms as women with lower education had 'reasons' not to react. Research is needed on how to overcome a wider spectrum of psycho-social factors to reduce future inequality. Statement of contribution What is already known on this subject? Seven of ten breast cancers in the UK are diagnosed after people contact their doctor with symptoms. Women from lower socio-economic backgrounds are more likely to be diagnosed with advanced disease. There is little evidence related to potential drivers of this SES inequality. What does this study add? We qualitatively explored socio-economic (SES) differences in help-seeking for breast symptoms. Women with higher education were more confident about interpreting symptoms and navigating health care. Women with lower education were more reluctant to seek help due to fear of cancer.
Collapse
Affiliation(s)
- Afrodita Marcu
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Georgia Black
- Department of Applied Health Research, University College London, UK
| | - Peter Vedsted
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Faculty of Health, Aarhus University, Denmark
| | - Georgios Lyratzopoulos
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, UK
| | | |
Collapse
|
27
|
Winstanley K, Renzi C, Smith CF, Wardle J, Whitaker KL. The impact of body vigilance on help-seeking for cancer 'alarm' symptoms: a community-based survey. BMC Public Health 2016; 16:1172. [PMID: 27871273 PMCID: PMC5117619 DOI: 10.1186/s12889-016-3846-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/15/2016] [Indexed: 12/19/2022] Open
Abstract
Background The act of detecting bodily changes is a pre-requisite for subsequent responses to symptoms, such as seeking medical help. This is the first study to explore associations between self-reported body vigilance and help-seeking in a community sample currently experiencing cancer ‘alarm’ symptoms. Methods Using a cross-sectional study design, a ‘health survey’ was mailed through primary care practices to 4913 UK adults (age ≥50 years, no cancer diagnosis), asking about symptom experiences and medical help-seeking over the previous three months. Body vigilance, cancer worry and current illness were assessed with a small number of self-report items derived from existing measures. Results The response rate was 42% (N = 2042). Almost half the respondents (936/2042; 46%) experienced at least one cancer alarm symptom. Results from logistic regression analysis revealed that paying more attention to bodily changes was significantly associated with help-seeking for cancer symptoms (OR = 1.44; 1.06-1.97), after controlling for socio-demographics, current illness and cancer worry. Being more sensitive to bodily changes was not significantly associated with help-seeking. Conclusions Respondents who paid attention to their bodily changes were more likely to seek help for their symptoms. Although the use of a cross-sectional study design and the limited assessment of key variables preclude any firm conclusions, encouraging people to be body vigilant may contribute towards earlier cancer diagnosis. More needs to be understood about the impact this might have on cancer-related anxiety.
Collapse
Affiliation(s)
- Kelly Winstanley
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
| | - Cristina Renzi
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
| | - Claire Friedemann Smith
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
| | - Katriina L Whitaker
- School of Health Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK.
| |
Collapse
|
28
|
Marcu A, Lyratzopoulos G, Black G, Vedsted P, Whitaker KL. Educational differences in likelihood of attributing breast symptoms to cancer: a vignette-based study. Psychooncology 2016; 25:1191-1197. [PMID: 27218858 DOI: 10.1002/pon.4177] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/06/2016] [Accepted: 05/17/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Stage at diagnosis of breast cancer varies by socio-economic status (SES), with lower SES associated with poorer survival. We investigated associations between SES (indexed by education), and the likelihood of attributing breast symptoms to breast cancer. METHOD We conducted an online survey with 961 women (47-92 years) with variable educational levels. Two vignettes depicted familiar and unfamiliar breast changes (axillary lump and nipple rash). Without making breast cancer explicit, women were asked 'What do you think this […..] could be?' After the attribution question, women were asked to indicate their level of agreement with a cancer avoidance statement ('I would not want to know if I have breast cancer'). RESULTS Women were more likely to mention cancer as a possible cause of an axillary lump (64%) compared with nipple rash (30%). In multivariable analysis, low and mid education were independently associated with being less likely to attribute a nipple rash to cancer (OR 0.51, 0.36-0.73 and OR 0.55, 0.40-0.77, respectively). For axillary lump, low education was associated with lower likelihood of mentioning cancer as a possible cause (OR 0.58, 0.41-0.83). Although cancer avoidance was also associated with lower education, the association between education and lower likelihood of making a cancer attribution was independent. CONCLUSION Lower education was associated with lower likelihood of making cancer attributions for both symptoms, also after adjustment for cancer avoidance. Lower likelihood of considering cancer may delay symptomatic presentation and contribute to educational differences in stage at diagnosis. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Afrodita Marcu
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Georgios Lyratzopoulos
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Georgia Black
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Peter Vedsted
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Faculty of Health, Aarhus University, Denmark
| | | |
Collapse
|
29
|
Worrying about wasting GP time as a barrier to help-seeking: a community-based, qualitative study. Br J Gen Pract 2016; 66:e474-82. [PMID: 27215569 PMCID: PMC4917050 DOI: 10.3399/bjgp16x685621] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/15/2016] [Indexed: 12/28/2022] Open
Abstract
Background Worrying about wasting GP time is frequently cited as a barrier to help-seeking for cancer symptoms. Aim To explore the circumstances under which individuals feel that they are wasting GP time. Design and setting Community-based, qualitative interview studies that took place in London, the South East and the North West of England. Method Interviewees (n = 62) were recruited from a sample (n = 2042) of adults aged ≥50 years, who completed a ‘health survey’ that included a list of cancer ‘alarm’ symptoms. Individuals who reported symptoms at baseline that were still present at the 3-month follow-up (n = 271), and who had also consented to be contacted (n = 215), constituted the pool of people invited for interview. Analyses focused on accounts of worrying about wasting GP time. Results Participants were worried about wasting GP time when time constraints were visible, while dismissive interactions with their GP induced a worry of unnecessary help-seeking. Many felt that symptoms that were not persistent, worsening, or life-threatening did not warrant GP attention. Additionally, patients considered it time-wasting when they perceived attention from nurses or pharmacists to be sufficient, or when appointment structures (for example, ‘one issue per visit’) were not adhered to. Close relationships with GPs eased worries about time-wasting, while some patients saw GPs as fulfilling a service financed by taxpayers. Conclusion Worrying about wasting GP time is a complex barrier to help-seeking. GP time and resource scarcity, symptom gravity, appointment etiquette, and previous GP interactions contribute to increasing worries. Friendly GP relationships, economic reasoning, and a focus on the GP’s responsibilities as a medical professional reduce this worry.
Collapse
|