1
|
Shaw B, Walter FM, Hamilton W, Martins T. Symptom appraisal and help seeking in males with symptoms of possible prostate cancer: a qualitative study with an ethnically diverse sample in London. Br J Gen Pract 2023; 73:e502-e510. [PMID: 37253629 PMCID: PMC10242866 DOI: 10.3399/bjgp.2022.0554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/07/2022] [Accepted: 03/23/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Prostate cancer mortality in Black males is disproportionately high. This problem may be overcome by reducing delays in the pathway to diagnosis, particularly those occurring before initial medical help seeking. A greater understanding of symptom appraisal and help seeking could support the development of targeted interventions for improving early presentation among Black males. AIM To provide an in-depth understanding of males' pre-consultation experiences following the onset of symptoms of possible prostate cancer, identifying both general trends as well as potential differences that may exist between Black and White males. DESIGN AND SETTING Qualitative study of 18 males (nine Black, nine White) in London, UK, who had recently seen their GP with urinary symptoms, erectile dysfunction, or haematuria. METHOD Semi-structured interviews from a previous multi-methods study of primary care use by males with symptoms of possible prostate cancer were analysed using thematic framework analysis. RESULTS Symptoms were often interpreted by patients as unimportant. Most delays occurred due to the absence of reasons to seek help, which, in Black males, often stemmed from poor awareness of prostate cancer. This lack of awareness could have been a consequence of their reluctance to seek health information and discuss health issues with others in their social network. Friends and relatives played an important role in symptom appraisal and help seeking. CONCLUSION Cognitive biases, cultural stigmas, and everyday interpersonal interactions should be important areas at which to target strategies seeking to reduce delays and improve early presentation in males with possible prostate cancer, particularly Black males.
Collapse
Affiliation(s)
- Ben Shaw
- College of Medicine and Health, University of Exeter, Exeter
| | - Fiona M Walter
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London; Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
| | | | | |
Collapse
|
2
|
Kourouni I, Suguness A, Finley J, Josan ES, Dutton K, Tarabichi Y. Reducing Racial Disparities in the Timeliness of Potential Lung Cancer Evaluation With a Novel Application-Supported Rapid Outpatient Diagnostic Program: An Interrupted Time Series Analysis. Clin Lung Cancer 2023; 24:339-346. [PMID: 37002154 PMCID: PMC10225315 DOI: 10.1016/j.cllc.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Rapid outpatient diagnostic programs (RODP) expedite lung cancer evaluation, but their impact on racial disparities in the timeliness of evaluation is less clear. MATERIALS AND METHODS This was a retrospective analysis of the impact of an internally developed application-supported RODP on racial disparities in timely referral completion rates for patients with potential lung cancer at a safety-net healthcare system. An application screened referrals to pulmonology for indications of lung mass or nodule and presented relevant clinical information that enabled dedicated pulmonologists to efficiently review and triage cases according to urgency. Subsequent care coordination was overseen by a dedicated nurse coordinator. To determine the program's impact, we conducted an interrupted time series analysis of the monthly fraction of referrals completed within 30 days, stratified by those identified as White, non-Hispanic and those that were not (racial and ethnic minorities). RESULTS There were 902 patients referred in the 2 years preintervention and 913 in the 2 years postintervention. Overall, the median age was 63 years, and 44.7% of referred patients were female. 44.2% were White, non-Hispanic while racial and ethnic minorities constituted 54.3%. After the intervention, there was a significant improvement in the proportion of referrals completed within 30 days (62.4% vs. 48.2%, P <.01). The interrupted time series revealed a significant immediate improvement in timely completion among racial and ethnic minorities (23%, P < .01) that was not reflected in the majority White, non-Hispanic subgroup (11%, not significant). CONCLUSION A thoughtfully designed and implemented RODP reduced racial disparities in the timely evaluation of potential lung cancer.
Collapse
Affiliation(s)
- Ismini Kourouni
- Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth, Cleveland, OH; School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Arvind Suguness
- Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth, Cleveland, OH; School of Medicine, Case Western Reserve University, Cleveland, OH; Center for Clinical Informatics Research and Education, MetroHealth, Cleveland, OH
| | - James Finley
- Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth, Cleveland, OH; School of Medicine, Case Western Reserve University, Cleveland, OH
| | | | - Katherine Dutton
- Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth, Cleveland, OH
| | - Yasir Tarabichi
- Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth, Cleveland, OH; School of Medicine, Case Western Reserve University, Cleveland, OH; Center for Clinical Informatics Research and Education, MetroHealth, Cleveland, OH.
| |
Collapse
|
3
|
Early diagnosis of symptomatic ovarian cancer in primary care in the UK: opportunities and challenges. Prim Health Care Res Dev 2022; 23:e52. [PMID: 36052862 PMCID: PMC9472236 DOI: 10.1017/s146342362200041x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Ovarian cancer is the sixth most common cause of cancer-related death in the UK amongst women. Ovarian cancer presents particular challenges for general practitioners (GPs) to diagnose due to its rarity and presentation with non-specific symptoms. Methods: A narrative overview of the literature was conducted by searching PubMed and Researchgate for relevant articles, using keywords such as “ovarian cancer,” “primary care” and “diagnosis.” Results and Discussion: Studies have shown that in the UK, GPs have a lower readiness to refer and investigate potential cancer symptoms compared with their international counterparts; and this has been correlated with reduced survival. Early diagnosis can be facilitated through a people-focussed and system-based approach which involves both educating GPs and using risk algorithms, rapid diagnostic centres/multi-disciplinary centres and being data-driven through the identification of best practice from national audits. Further research is required into the best evidence-based early investigations for ovarian cancer and more effective biomarkers.
Collapse
|
4
|
Dave RV, Bromley H, Taxiarchi VP, Camacho E, Chatterjee S, Barnes N, Hutchison G, Bishop P, Hamilton W, Kirwan CC, Gandhi A. No association between breast pain and breast cancer: a prospective cohort study of 10 830 symptomatic women presenting to a breast cancer diagnostic clinic. Br J Gen Pract 2022; 72:e234-e243. [PMID: 34990395 PMCID: PMC8869188 DOI: 10.3399/bjgp.2021.0475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/10/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Women with breast pain constitute >20% of breast clinic attendees. AIM To investigate breast cancer incidence in women presenting with breast pain and establish the health economics of referring women with breast pain to secondary care. DESIGN AND SETTING A prospective cohort study of all consecutive women referred to a breast diagnostic clinic over 12 months. METHOD Women were categorised by presentation into four distinct clinical groups and cancer incidence investigated. RESULTS Of 10 830 women, 1972 (18%) were referred with breast pain, 6708 (62%) with lumps, 480 (4%) with nipple symptoms, 1670 (15%) with 'other' symptoms. Mammography, performed in 1112 women with breast pain, identified cancer in eight (0.7%). Of the 1972 women with breast pain, breast cancer incidence was 0.4% compared with ∼5% in each of the three other clinical groups. Using 'breast lump' as reference, the odds ratio (OR) of women referred with breast pain having breast cancer was 0.05 (95% confidence interval = 0.02 to 0.09, P<0.001). Compared with reassurance in primary care, referral was more costly (net cost £262) without additional health benefits (net quality-adjusted life-year [QALY] loss -0.012). The greatest impact on the incremental cost-effectiveness ratio (ICER) was when QALY loss because of referral-associated anxiety was excluded. Primary care reassurance no longer dominated, but the ICER remained greater (£45 528/QALY) than typical UK National Health Service cost-effectiveness thresholds. CONCLUSION This study shows that referring women with breast pain to a breast diagnostic clinic is an inefficient use of limited resources. Alternative management pathways could improve capacity and reduce financial burden.
Collapse
Affiliation(s)
- Rajiv V Dave
- Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester
| | - Hannah Bromley
- Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester
| | - Vicky P Taxiarchi
- Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Elizabeth Camacho
- Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Sumohan Chatterjee
- Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester
| | - Nicola Barnes
- Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester
| | - Gillian Hutchison
- Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester
| | - Paul Bishop
- Clinical Sciences, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester
| | | | - Cliona C Kirwan
- Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester and Manchester Breast Centre, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oglesby Cancer Research Building, Manchester, UK
| | - Ashu Gandhi
- Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester and Manchester Breast Centre, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oglesby Cancer Research Building, Manchester, UK
| |
Collapse
|
5
|
Chiva Giurca B, Hamilton W, Martins T. The impact of health literacy on diagnosis and outcomes of symptomatic cancer by ethnicity: a systematic review protocol. Syst Rev 2018; 7:164. [PMID: 30326949 PMCID: PMC6192147 DOI: 10.1186/s13643-018-0831-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/01/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Ethnic minorities in multi-ethnic societies like the UK and USA have poorer outcomes for some cancer types when compared with the majority. The causes of ethnic inequalities in cancer outcomes are complex and not fully understood. In particular, the potential role of health literacy on symptomatic presentation and diagnostic interval (the period between first consultation within primary care and definitive diagnosis of cancer) by ethnicity is unknown. Given the increasing need for shared decision-making and patient involvement in the diagnostic process, understanding the potential impact of the differences in health literacy may help redress ethnic inequality in cancer outcomes. The present study aims to critically examine the evidence in this area. METHODS Seven electronic databases will be searched using keywords and controlled vocabulary related to ethnicity, health literacy, cancer diagnosis and cancer outcomes. Citations and bibliography searches of included studies will be performed to identify relevant studies that have cited eligible articles. Authors of included studies will be contacted to identify unpublished studies. Eligible studies will be restricted to primary cancers. Study quality will be evaluated in using the Critical Appraisal Skills Programme (CASP) checklists. A descriptive summary of selected studies will be presented, and the synthesis will follow a narrative framework. DISCUSSION This systematic review will summarise the evidence regarding ethnic inequality in health literacy and how this impacts on diagnosis and outcomes of cancer. The review will identify possible areas for future research, and inform clinical practice and interventions to reduce ethnic inequalities in cancer diagnosis and outcomes.
Collapse
Affiliation(s)
- Bogdan Chiva Giurca
- University of Exeter Medical School, Room G02 Medical School Building, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - William Hamilton
- University of Exeter Medical School, Room G02 Medical School Building, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Tanimola Martins
- University of Exeter Medical School, Room G02 Medical School Building, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| |
Collapse
|
6
|
Kam S, Bylstra Y, Forrest L, Macciocca I, Foo R. Experience of Asian males communicating cardiac genetic risk within the family. J Community Genet 2018; 9:293-303. [PMID: 29308542 DOI: 10.1007/s12687-017-0352-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/09/2017] [Accepted: 12/18/2017] [Indexed: 11/24/2022] Open
Abstract
The genetic nature of an inherited cardiac condition (ICC) places first- and second-degree relatives at risk of cardiac complications and sudden death, even in the absence of symptoms. Communication of cardiac genetic risk information allows at-risk relatives to clarify, manage, and potentially prevent ICC-associated risks through cardiac screening. Literature regarding family communication of genetic risk information are predominantly based on Western populations, with limited insight into the Asian experience. This qualitative exploratory study provides a male perspective into the communication of ICC risks within families in Singapore. Eight male participants with clinically diagnosed cardiomyopathy, who had all received genetic counseling, were recruited. A phenomenological perspective was used to identify emergent themes from semi-structured interviews. In this study, most participants recalled their healthcare professional's emphasis on family communication. Notably, participants revealed that at-risk relatives were not accessing screening, and many described family members as currently asymptomatic and "healthy." These findings coincide with documented Asian beliefs regarding perceptions of health, which have important implications for the provision of genetic counseling support within Asian communities, especially in facilitating family communication such that at-risk relatives are informed about their ICC risks and available management options.
Collapse
Affiliation(s)
- Sylvia Kam
- POLARIS @ SingHealth, Singapore Health Services, 20 College Road, The Academia, Discovery Tower, Level 10, Singapore, 169856, Singapore.
- Department of Paediatrics, The University of Melbourne, Reception Level 2, West Building, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.
| | - Yasmin Bylstra
- SingHealth Duke-NUS Institute of Precision Medicine, Level 9, National Heart Centre, 5 Hospital Drive, Singapore, 169609, Singapore
- Inherited Cardiac Conditions Clinic, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Laura Forrest
- Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Ivan Macciocca
- Victorian Clinical Genetics Services, Murdoch Childrens Research Institute, 4th Floor, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052, Australia
| | - Roger Foo
- Cardiovascular Research Institute, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, 119228, Singapore
- Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 8, MD6, 14 Medical Drive, Singapore, 117599, Singapore
| |
Collapse
|
7
|
Thøgersen H, Møller B, Robsahm TE, Aaserud S, Babigumira R, Larsen IK. Comparison of cancer stage distribution in the immigrant and host populations of Norway, 1990-2014. Int J Cancer 2017; 141:52-61. [DOI: 10.1002/ijc.30713] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 03/13/2017] [Accepted: 03/17/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Håvard Thøgersen
- Cancer Registry of Norway, Institute of Population-Based Cancer Research; Norway
- University of Oslo, Faculty of Medicine, Institute of Basic Medical Sciences; Norway
| | - Bjørn Møller
- Cancer Registry of Norway, Institute of Population-Based Cancer Research; Norway
| | - Trude Eid Robsahm
- Cancer Registry of Norway, Institute of Population-Based Cancer Research; Norway
| | - Stein Aaserud
- Cancer Registry of Norway, Institute of Population-Based Cancer Research; Norway
| | - Ronnie Babigumira
- Cancer Registry of Norway, Institute of Population-Based Cancer Research; Norway
| | - Inger Kristin Larsen
- Cancer Registry of Norway, Institute of Population-Based Cancer Research; Norway
| |
Collapse
|