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Collins A, Molina Kuna E, Anderson-Mellies A, Cost C, Green AL. Investigating the Impact of Tumor Biology and Social Determinants on Time to Diagnosis and Stage at Presentation of Wilms Tumor. J Pediatr Hematol Oncol 2024; 46:147-153. [PMID: 38447110 PMCID: PMC10956656 DOI: 10.1097/mph.0000000000002846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 02/04/2024] [Indexed: 03/08/2024]
Abstract
Delays in diagnosis and time to diagnosis generally are used interchangeably in cancer disparity research, but these terms may have important differences. Although these terms are related, we hypothesize that time to diagnosis is determined by the aggressiveness of the tumor based on intrinsic factors such as tumor biology, whereas delays in diagnosis are caused by extrinsic factors such as socioeconomic status, leading to presentation at higher stage of disease due to barriers of care. We conducted a retrospective study of 306 patients diagnosed with Wilms tumor at Children's Hospital Colorado between 1971 and 2016 identifying patient barriers as extrinsic markers and using unfavorable histology and loss of heterozygosity as markers of aggressive tumor biology. Multivariable logistic regression was performed. Patients with Medicaid were more likely to present greater than 4 days after initial symptoms compared to those with private insurance, and those with housing concerns were more likely to be diagnosed greater than 9 days from initial symptoms. Tumor biology was noted to be associated with higher stage at diagnosis, but patient barriers were not. These findings suggest the interplay between tumor biology, patient barriers, diagnostic timing, and stage at diagnosis is more complex, multifactorial, and in need of further study.
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Affiliation(s)
| | - Elizabeth Molina Kuna
- University of Colorado School of Medicine
- Department of Medicine
- Division of Medical Oncology
- University of Colorado Cancer Center
- Population Health Shared Resource
| | - Amy Anderson-Mellies
- University of Colorado School of Medicine
- Department of Medicine
- Division of Medical Oncology
- University of Colorado Cancer Center
- Population Health Shared Resource
| | - Carrye Cost
- University of Colorado School of Medicine
- University of Colorado Cancer Center
- Children’s Hospital Colorado
| | - Adam L. Green
- University of Colorado School of Medicine
- University of Colorado Cancer Center
- Children’s Hospital Colorado
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2
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Zheng J, Guo AH, Xue BW, Wu SY, Wang XX, Jing YJ, Zhai LJ, Liu R. Exploring patient delay in people with chronic kidney disease: A cross-sectional study. Medicine (Baltimore) 2024; 103:e37077. [PMID: 38363926 PMCID: PMC10869059 DOI: 10.1097/md.0000000000037077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/05/2024] [Indexed: 02/18/2024] Open
Abstract
To examine the factors that contribute to patient delays among individuals with chronic kidney disease (CKD) and offer insights to help develop specific risk management strategies. Conducted as a cross-sectional study between September 2021 and April 2022, this study used a convenient sampling technique to select 245 individuals diagnosed with CKD from a Grade 3 Class A hospital located in Shanxi Province. These individuals were chosen as the subjects of the study. The research participants underwent an investigation using several assessment tools, including socio-demographic information questionnaire, medical behavior, the social support rating scale, the simplified coping style questionnaire, and the General Self-efficacy Scale. The study revealed that 35.4% of individuals with CKD experienced patient delay (the interval between the initial onset and the time of seeking medical attention being longer than or equal to 3 months). Through a multifactorial logistic regression analysis, it was determined that various factors independently influenced patient delay in patients with CKD. These factors included the level of knowledge about CKD, educational level, frequency of attending physical examinations, severity of initial symptoms, social support, self-efficacy, positive coping, and negative coping. Numerous factors contribute to the Patient Delay. To effectively enhance awareness and coping abilities regarding CKD in high-risk groups, it is essential to implement focused and continuous interventions throughout the medical seeking process.
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Affiliation(s)
- Jie Zheng
- Nursing College of Shanxi Medical University, Shanxi, China
| | - Ao-Han Guo
- Nursing College of Shanxi Medical University, Shanxi, China
| | - Bo-Wen Xue
- Nursing College, Hangzhou Normal University, Hangzhou, China
| | - Shu-Yan Wu
- Nursing College of Shanxi Medical University, Shanxi, China
| | | | - Yue-Juan Jing
- The Second Hospital of Shanxi Medicine University, Shanxi, China
| | - Lin-Jun Zhai
- Nursing College of Shanxi Medical University, Shanxi, China
| | - Rong Liu
- Nursing College of Shanxi Medical University, Shanxi, China
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Fjällström P, Hörnsten C, Lilja M, Hultstrand C, Coe AB, Hajdarevic S. Reduction in the diagnostic interval after the introduction of cancer patient pathways for colorectal cancer in northern Sweden. Scand J Prim Health Care 2023; 41:287-296. [PMID: 37450480 PMCID: PMC10478615 DOI: 10.1080/02813432.2023.2234003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE To compare the diagnostic interval for patients with colorectal cancer before and after the introduction of cancer patient pathways in northern Sweden. DESIGN A retrospective study comparing two cohorts (2012 and 2018) of patients diagnosed with colorectal cancer before and after the introduction of cancer patient pathways in 2016. SETTING Three counties in northern Sweden with large sparsely populated areas and some cities (637143 residents ∼5.1 residents/km2). SUBJECTS Patients were included from the Swedish Cancer Register. Electronic health records reviews were performed and linked to socioeconomic data from Statistics Sweden. MAIN OUTCOME MEASURES Differences in the diagnostic intervals, the patient intervals and the characteristics associated with the longest diagnostic intervals and investigations starting at the emergency department. RESULTS The two cohorts included 411 patients in 2012 and 445 patients in 2018. The median diagnostic interval was reduced from 47 days (IQI 18-99) to 29 days (IQI 9-74) (p < 0.001) after the introduction of cancer patient pathways in general. Though for the cases of cancer in the right-side (ascended) colon, the reduction of the diagnostic interval was not observed and it remained associated with investigations starting at the emergency department. CONCLUSION Our results indicate that cancer patient pathways contributed to an improvement in the diagnostic interval for patients with colorectal cancer in general, yet not for patients with cancer in the right-side colon. IMPLICATION In general, cancer patient pathways seem to reduce the diagnostic interval for colorectal cancer but it is not a sufficient solution for all colorectal cancer localisations.
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Affiliation(s)
- P. Fjällström
- Department of Nursing, Umeå University, Umeå, Sweden
| | - C. Hörnsten
- Department of Clinical Sciences, Psychiatry, Umeå university, Umeå, Sweden
| | - M. Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education, and Development, Östersund Hospital, Umeå University, Umeå, Sweden
| | - C. Hultstrand
- Department of Nursing, Umeå University, Umeå, Sweden
| | - A. B. Coe
- Department of Sociology, Umeå University, Umeå, Sweden
| | - S. Hajdarevic
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
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Damsees R, Jaghbir M, Salam M, Al-Omari A, Al-Rawashdeh N. Unravelling the predictors of late cancer presentation and diagnosis in Jordan: a cross-sectional study of patients with lung and colorectal cancers. BMJ Open 2023; 13:e069529. [PMID: 37130680 PMCID: PMC10163555 DOI: 10.1136/bmjopen-2022-069529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES Late presentation or diagnosis of cancer results in a poor clinical prognosis, negatively affects treatment and subsequently lowers one's chances of survival. This study aimed to identify the factors associated with late lung and colorectal cancer presentation and diagnosis in Jordan. DESIGN This correlational cross-sectional study was based on face-to-face interviews and medical chart reviews from a cancer registry database. A structured questionnaire based on a review of the literature was used. SETTING AND PARTICIPANTS The study participants were a representative sample of adult patients with colorectal or lung cancer who visited the outpatient clinics at King Hussein Cancer Center in Amman, Jordan, between January 2019 and December 2020, to get their first medical consultation. RESULTS 382 study participants were surveyed, with a response rate of 82.3%. Of these, 162 (42.2%) reported a late presentation and 92 (24.1%) reported a late diagnosis of cancer. The results of backward multivariate logistic regression analyses showed that female gender and not seeking a medical advice when feeling ill combined was associated with an almost three times increased likelihood of reporting a late presentation with cancer (adjusted OR 2.97, 95% CI 1.19 to 7.43). Not having health insurance and not seeking medical advice combined was also associated with late presentation (2.5, 95% CI 1.02 to 6.12). For lung cancer, Jordanians living in rural areas were 9.29 (95% CI 2.46 to 35.1) times more likely to report late diagnosis. Jordanians who did not screen for cancer in the past were 7.02 (95% CI 1.69 to 29.18) times more likely to report late diagnosis. For colorectal cancer, those having no previous knowledge about cancers or screening programmes had increased odds of reporting late diagnosis (2.30, 95% CI 1.06 to 4.97). CONCLUSIONS This study highlights important factors associated with the late presentation and diagnosis of colorectal and lung cancers in Jordan. Investing in national screening and early detection programmes as well as public outreach and awareness campaigns will have a significant impact on early detection to improve treatment outcomes.
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Affiliation(s)
- Rana Damsees
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
- Department of Science, Technology and Research, UAE Ministry of Education, Abu Dhabi, UAE
| | - Madi Jaghbir
- Department of Family and Community Medicine, The University of Jordan, Amman, Jordan
| | - Mahmoud Salam
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Amal Al-Omari
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Nedal Al-Rawashdeh
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
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Botey AP, Barber T, Robson PJ, O'Neill BM, Green LA. Using care pathways for cancer diagnosis in primary care: a qualitative study to understand family physicians' mental models. CMAJ Open 2023; 11:E486-E493. [PMID: 37279982 DOI: 10.9778/cmajo.20220084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Care pathways are tools that can help family physicians navigate the complexities of the cancer diagnostic process. Our objective was to examine the mental models associated with using care pathways for cancer diagnosis of a group of family physicians in Alberta. METHODS We conducted a qualitative study using cognitive task analysis, with interviews in the primary care setting between February and March 2021. Family physicians whose practices were not heavily oriented toward patients with cancer and who did not work closely with specialized cancer clinics were recruited with the support of the Alberta Medical Association and leveraging our familiarity with Alberta's Primary Care Networks. We conducted simulation exercise interviews with 3 pathway examples over Zoom, and we analyzed data using both macrocognition theory and thematic analysis. RESULTS Eight family physicians participated. Macrocognitive functions (and subthemes) related to mental models were sense-making and learning (confirmation and validation, guidance and support, and sense-giving to patients), care coordination and diagnostic decision-making (shared understanding). Themes related to the use of the pathways were limited use in diagnosis decisions, use in guiding and supporting referral, only relevant and easy-to-process information, and easily accessible. INTERPRETATION Our findings suggest the importance of designing pathways intentionally for streamlined integration into family physicians' practices, highlighting the need for co-design approaches. Pathways were identified as a tool that, used in combination with other tools, may help gather information and support cancer diagnosis decisions, with the goals of improving patient outcomes and care experience.
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Affiliation(s)
- Anna Pujadas Botey
- Cancer Strategic Clinical Network (Pujadas Botey), Alberta Health Services, Calgary, Alta.; School of Public Health (Pujadas Botey, Robson) and Department of Family Medicine (Barber, Green), University of Alberta; Cancer Strategic Clinical Network (O'Neill, Robson), Alberta Health Services, Edmonton, Alta.
| | - Tanya Barber
- Cancer Strategic Clinical Network (Pujadas Botey), Alberta Health Services, Calgary, Alta.; School of Public Health (Pujadas Botey, Robson) and Department of Family Medicine (Barber, Green), University of Alberta; Cancer Strategic Clinical Network (O'Neill, Robson), Alberta Health Services, Edmonton, Alta
| | - Paula J Robson
- Cancer Strategic Clinical Network (Pujadas Botey), Alberta Health Services, Calgary, Alta.; School of Public Health (Pujadas Botey, Robson) and Department of Family Medicine (Barber, Green), University of Alberta; Cancer Strategic Clinical Network (O'Neill, Robson), Alberta Health Services, Edmonton, Alta
| | - Barbara M O'Neill
- Cancer Strategic Clinical Network (Pujadas Botey), Alberta Health Services, Calgary, Alta.; School of Public Health (Pujadas Botey, Robson) and Department of Family Medicine (Barber, Green), University of Alberta; Cancer Strategic Clinical Network (O'Neill, Robson), Alberta Health Services, Edmonton, Alta
| | - Lee A Green
- Cancer Strategic Clinical Network (Pujadas Botey), Alberta Health Services, Calgary, Alta.; School of Public Health (Pujadas Botey, Robson) and Department of Family Medicine (Barber, Green), University of Alberta; Cancer Strategic Clinical Network (O'Neill, Robson), Alberta Health Services, Edmonton, Alta
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Jin Y, Zheng MC, Yang X, Chen TL, Zhang JE. Patient delay and its predictors among colorectal cancer patients: A cross-sectional study based on the Theory of Planned Behavior. Eur J Oncol Nurs 2022; 60:102174. [DOI: 10.1016/j.ejon.2022.102174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/28/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
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Implementing and Sustaining Early Cancer Diagnosis Initiatives in Canada: An Exploratory Qualitative Study. Curr Oncol 2021; 28:4341-4356. [PMID: 34898549 PMCID: PMC8628805 DOI: 10.3390/curroncol28060369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The interval between suspected cancer and diagnosis for symptomatic patients is often fragmented, leading to diagnosis delays and increased patient stress. We conducted an exploratory qualitative study to explore barriers and facilitators to implementing and sustaining current initiatives across Canada that optimize early cancer diagnosis, with particular relevance for symptomatic patients. Methods: The national study included a document review and key informant interviews with purposefully recruited participants. Data were analyzed by two researchers using descriptive statistics and thematic analysis. Results: Twenty-two participants from eight provinces participated in key informant interviews and reported on 17 early cancer diagnosis initiatives. Most initiatives (88%) were in early phases of implementation. Two patient-facing and eight provider/organization barriers to implementation (e.g., lack of stakeholder buy-in and limited resources) and five facilitators for implementation and sustainability were identified. Opportunities to improve early cancer diagnosis initiatives included building relationships with stakeholders, co-creating initiatives, developing initiatives for Indigenous and underserved populations, optimizing efficiency and sustainability, and standardizing metrics to evaluate impact. Conclusion: Early cancer diagnosis initiatives in Canada are in early implementation phases. Lack of stakeholder buy-in and limited resources pose a challenge to sustainability. We present opportunities for funders and policymakers to optimize the use and potential impact of early cancer diagnosis initiatives.
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Petersen GS, Laursen SGW, Jensen H, Maindal HT, Pedersen AF, Vedsted P, Virgilsen LF. Patients' health literacy is associated with timely diagnosis of cancer-A cross-sectional study in Denmark. Eur J Cancer Care (Engl) 2021; 31:e13532. [PMID: 34704640 DOI: 10.1111/ecc.13532] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/23/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Timely diagnosis of cancer is important for prognosis. Patients' health literacy (HL) may impact differences of diagnostic delays. Thus, we aim to explore the association between HL and diagnostic intervals in cancer. METHODS Questionnaire data were obtained from patients with cancer diagnosed in 2016 and their general practitioner (n = 3890). The primary care interval (PCI) and the diagnostic interval (DI) were calculated using dates from national registries and questionnaires. A long PCI and DI were defined as ≥75th percentile. HL was assessed using scales from the Health Literacy Questionnaire: engaging with healthcare providers (scale 6:Engagement, n = 3008), navigating in healthcare (scale 7:Navigation, n = 2827) and understanding health information (scale 9:Knowledge, n = 3002). Low HL was defined as a score ≤3. RESULTS Low HL was reported by 12.2% (Engagement), 27.0% (Navigation) and 9.3% (Knowledge) of the patients and associated with a long PCI after adjustment of socio-economic factors: Engagement (prevalence rate ratio [PRR] 1.27 [95% CI 1.01-1.60]), Navigation (PRR 1.41 [95% CI 1.10-1.80]) and Knowledge (PRR 1.32 [95% CI 1.03-1.68]). No association was found between HL and DI. CONCLUSION HL may interfere with the diagnostic processes in general practice. Efforts to manage low HL include GPs' awareness of patients' ability to explain and respond to bodily changes and use of corresponding safety-netting strategies.
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Affiliation(s)
| | | | - Henry Jensen
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus, Denmark
| | | | - Anette F Pedersen
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus, Denmark
| | - Line Flytkjaer Virgilsen
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus, Denmark
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Botey AP, GermAnn K, Robson PJ, O'Neill BM, Stewart DA. Physician perspectives on delays in cancer diagnosis in Alberta: a qualitative study. CMAJ Open 2021; 9:E1120-E1127. [PMID: 34848553 PMCID: PMC8648351 DOI: 10.9778/cmajo.20210013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Delays in cancer diagnosis have been associated with reduced survival, decreased quality of life after treatment, and suboptimal patient experience. The objective of the study was to explore the perspectives of a group of family physicians and other specialists regarding potentially avoidable delays in diagnosing cancer, and approaches that may help expedite the process. METHODS We conducted a qualitative study using interviews with physicians practising in primary and outpatient care settings in Alberta between July and September 2019. We recruited family physicians and specialists who were in a position to discuss delays in cancer diagnosis by email via the Cancer Strategic Clinical Network and the Alberta Medical Association. We conducted semistructured interviews over the phone, and analyzed data using thematic analysis. RESULTS Eleven family physicians and 22 other specialists (including 7 surgeons or surgical oncologists, 3 pathologists, 3 radiologists, 2 emergency physicians and 2 hematologists) participated in interviews; 22 were male (66.7%). We identified 4 main themes describing 9 factors contributing to potentially avoidable delays in diagnosis, namely the nature of primary care, initial presentation, investigation, and specialist advice and referral. We also identified 1 theme describing 3 suggestions for improvement, including system integration, standardized care pathways and a centralized advice, triage and referral support service for family physicians. INTERPRETATION These findings suggest the need for enhanced support for family physicians, and better integration of primary and specialty care before cancer diagnosis. A multifaceted and coordinated approach to streamlining cancer diagnosis is required, with the goals of enhancing patient outcomes, reducing physician frustration and optimizing efficiency.
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Affiliation(s)
- Anna Pujadas Botey
- Cancer Strategic Clinical Network (Pujadas Botey, Stewart), Alberta Health Services, Calgary, Alta.; School of Public Health (Pujadas Botey), University of Alberta, Edmonton, Alta.; Independent health services researcher (GermAnn), Lacombe County, Alta.; Cancer Strategic Clinical Network (Robon, O'Neill), Alberta Health Services, Edmonton, Alta.; Cancer Care Alberta (Robson), Alberta Health Services, Edmonton, Alta.; Departments of Oncology and Medicine (Stewart), University of Calgary, Calgary, Alta.
| | - Kathy GermAnn
- Cancer Strategic Clinical Network (Pujadas Botey, Stewart), Alberta Health Services, Calgary, Alta.; School of Public Health (Pujadas Botey), University of Alberta, Edmonton, Alta.; Independent health services researcher (GermAnn), Lacombe County, Alta.; Cancer Strategic Clinical Network (Robon, O'Neill), Alberta Health Services, Edmonton, Alta.; Cancer Care Alberta (Robson), Alberta Health Services, Edmonton, Alta.; Departments of Oncology and Medicine (Stewart), University of Calgary, Calgary, Alta
| | - Paula J Robson
- Cancer Strategic Clinical Network (Pujadas Botey, Stewart), Alberta Health Services, Calgary, Alta.; School of Public Health (Pujadas Botey), University of Alberta, Edmonton, Alta.; Independent health services researcher (GermAnn), Lacombe County, Alta.; Cancer Strategic Clinical Network (Robon, O'Neill), Alberta Health Services, Edmonton, Alta.; Cancer Care Alberta (Robson), Alberta Health Services, Edmonton, Alta.; Departments of Oncology and Medicine (Stewart), University of Calgary, Calgary, Alta
| | - Barbara M O'Neill
- Cancer Strategic Clinical Network (Pujadas Botey, Stewart), Alberta Health Services, Calgary, Alta.; School of Public Health (Pujadas Botey), University of Alberta, Edmonton, Alta.; Independent health services researcher (GermAnn), Lacombe County, Alta.; Cancer Strategic Clinical Network (Robon, O'Neill), Alberta Health Services, Edmonton, Alta.; Cancer Care Alberta (Robson), Alberta Health Services, Edmonton, Alta.; Departments of Oncology and Medicine (Stewart), University of Calgary, Calgary, Alta
| | - Douglas A Stewart
- Cancer Strategic Clinical Network (Pujadas Botey, Stewart), Alberta Health Services, Calgary, Alta.; School of Public Health (Pujadas Botey), University of Alberta, Edmonton, Alta.; Independent health services researcher (GermAnn), Lacombe County, Alta.; Cancer Strategic Clinical Network (Robon, O'Neill), Alberta Health Services, Edmonton, Alta.; Cancer Care Alberta (Robson), Alberta Health Services, Edmonton, Alta.; Departments of Oncology and Medicine (Stewart), University of Calgary, Calgary, Alta
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Ansar A, Lewis V, McDonald CF, Liu C, Rahman MA. Duration of intervals in the care seeking pathway for lung cancer in Bangladesh: A journey from symptoms triggering consultation to receipt of treatment. PLoS One 2021; 16:e0257301. [PMID: 34506592 PMCID: PMC8432814 DOI: 10.1371/journal.pone.0257301] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 08/27/2021] [Indexed: 11/18/2022] Open
Abstract
Timeliness in seeking care is critical for lung cancer patients' survival and better prognosis. The care seeking trajectory of patients with lung cancer in Bangladesh has not been explored, despite the differences in health systems and structures compared to high income countries. This study investigated the symptoms triggering healthcare seeking, preferred healthcare providers (including informal healthcare providers such as pharmacy retailers, village doctors, and "traditional healers"), and the duration of intervals in the lung cancer care pathway of patients in Bangladesh. A cross-sectional study was conducted in three tertiary care hospitals in Bangladesh among diagnosed lung cancer patients through face-to-face interview and medical record review. Time intervals from onset of symptom and care seeking events were calculated and compared between those who sought initial care from different providers using Wilcoxon rank sum tests. Among 418 study participants, the majority (90%) of whom were males, with a mean age of 57 ±9.86 years, cough and chest pain were the most common (23%) combination of symptoms triggering healthcare seeking. About two-thirds of the total respondents (60%) went to informal healthcare providers as their first point of contact. Living in rural areas, lower levels of education and lower income were associated with seeking care from such providers. The median duration between onset of symptom to confirmation of diagnosis was 121 days, between confirmation of diagnosis and initiation of treatment was 22 days, and between onset of symptom and initiation of treatment was 151 days. Pre-diagnosis durations were longer for those who had sought initial care from an informal provider (p<0.05). Time to first contact with a health provider was shorter in this study compared to other developed and developing countries but utilizing informal healthcare providers caused delays in diagnosis and initiation of treatment. Encouraging people to seek care from a formal healthcare provider may reduce the overall duration of the care seeking pathway.
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Affiliation(s)
- Adnan Ansar
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Melbourne, Australia
- Institute for Breathing and Sleep (IBAS), Melbourne, Australia
| | - Virginia Lewis
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Melbourne, Australia
- Australian Institute for Primary Care and Aging, La Trobe University, Melbourne, Australia
| | - Christine Faye McDonald
- Institute for Breathing and Sleep (IBAS), Melbourne, Australia
- Department of Respiratory & Sleep Medicine, Austin Health, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Muhammad Aziz Rahman
- Institute for Breathing and Sleep (IBAS), Melbourne, Australia
- Australian Institute for Primary Care and Aging, La Trobe University, Melbourne, Australia
- School of Health, Federation University Australia, Berwick, Australia
- Department of Noncommunicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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11
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Lacombe V, Chabrun F, Lacout C, Ghali A, Capitain O, Patsouris A, Lavigne C, Urbanski G. Persistent elevation of plasma vitamin B12 is strongly associated with solid cancer. Sci Rep 2021; 11:13361. [PMID: 34172805 PMCID: PMC8233305 DOI: 10.1038/s41598-021-92945-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/15/2021] [Indexed: 12/17/2022] Open
Abstract
Elevated plasma vitamin B12 has been associated with solid cancers, based on a single B12 measurement. We evaluated the incidence of solid cancers following B12 measurement in patients with persistent elevated B12, compared to patients without elevated B12 and to patients with non-persistent elevated B12. The study population included patients with at least two plasma B12 measurements without already known elevated-B12-related causes. Patients with elevated plasma B12 (≥ 1000 ng/L) at first measurement (n = 344) were matched for age and sex with patients having 2 normal B12 measurements (< 1000 ng/L) (NN group, n = 344). The patients with elevated plasma B12 at first measurement were split into 2 groups, according to the presence (EE group, n = 144) or the absence (EN group, n = 200) of persistent elevated plasma B12 at second measurement. We compared the cancer-free survival during 60 months between the groups after adjustment for the other elevated-B12-related causes in a survival competing risk model. Compared to the NN group, a persistent elevated plasma B12 ≥ 1000 ng/mL was strongly associated with the occurrence of solid cancer (HR 5.90 [95% CI 2.79-12.45], p < 0.001), contrary to non-persistent plasma B12 elevation (p = 0.29). These results could help to select patients in whom the screening for solid cancers would be of interest.
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Affiliation(s)
- Valentin Lacombe
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, Angers, France
| | - Floris Chabrun
- Department of Biochemistry and Genetics, Angers University Hospital, Angers, France
| | - Carole Lacout
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, Angers, France
| | - Alaa Ghali
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, Angers, France
| | | | | | - Christian Lavigne
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, Angers, France
| | - Geoffrey Urbanski
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, Angers, France.
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 4 rue Larrey, 49000, Angers, France.
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Sathoo S, Nachiappan DS, Sureshkumar S, Anandhi A. A qualitative exploratory study of delay in the presentation of gastrointestinal cancer. J Family Med Prim Care 2021; 10:278-282. [PMID: 34017740 PMCID: PMC8132795 DOI: 10.4103/jfmpc.jfmpc_1283_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/13/2020] [Accepted: 09/17/2020] [Indexed: 01/04/2023] Open
Abstract
Introduction: Patients with gastrointestinal (GI) cancers often present late in the advanced stages, due to various reasons and may experience delays in treatment. Hence, we have attempted to find the factors leading to this delay. Methods: This was an exploratory qualitative study, in a tertiary care hospital, including 20 patients with advanced GI cancers. They were interviewed to assess the reasons for delays in presentation, diagnosis and treatment, and the factors were analysed based on the interval of delay and the cause. Results: This study found that there was an interval of delay of 8 months from the onset of symptoms till primary treatment, more than half of which occurred in the pre-hospital phase (56.4%). We classified the causes for the delay into different intervals such as the appraisal interval, health-seeking interval, diagnostic interval and the pre-treatment interval. Lapses at the individual, societal and institutional level lead to the delay. The major causes included ignorance, substance abuse, poverty, social stigma, vague symptoms and missed diagnosis, miscommunication, resource constrain, very poor doctor-patient ratio and delay in investigation and treatment. Conclusion: This study noted a significant delay in the treatment of patients with advanced gastrointestinal cancers. Reasons for delay have been noted at various levels. Further action based on this study, at the community and hospital level could potentially reduce the delay and result in better survival and improved quality of life.
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Affiliation(s)
- Saarat Sathoo
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | | | - Sathasivam Sureshkumar
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Amaranathan Anandhi
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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13
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Soomers VLMN, van der Graaf WTA, Zaidi S, Kaal SEJ, Hayes AJ, Schreuder BHWB, Jones RL, Desar IME, Husson O. The route to diagnosis of sarcoma patients: Results from an interview study in the Netherlands and the United Kingdom. PLoS One 2020; 15:e0243439. [PMID: 33284856 PMCID: PMC7721153 DOI: 10.1371/journal.pone.0243439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 11/21/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Sarcomas are rare tumours. Early diagnosis is challenging, but important for local control and potentially survival and quality of life(QoL). We investigated (1)the route to diagnosis (RtD) experienced by sarcoma patients, including factors contributing to the length of the RtD from patients' perspective; (2)the impact of the RtD on QoL and care satisfaction; and (3)differences in aims 1-2 between English and Dutch patients. METHODS Fifteen sarcoma patients from The Royal Marsden Hospital, United Kingdom, and Radboud University Medical Centre, The Netherlands, were interviewed, exploring RtD experiences. Interviews were analysed according to qualitative content analysis. RESULTS The main themes were: patient interval, diagnostic interval, reflection on the RtD and recommendations for improvement. Patient interval was long if symptoms were attributed as benign, did not interfere with daily life or were expected to cease. An incorrect working diagnosis, ineffective process of additional investigations, long referral times and lack of a lead clinician lengthened the diagnostic interval. Long waiting times, false reassurance and inadequate information provision led to dissatisfaction and a high emotional burden. Factors for improvement included increasing awareness of patients and healthcare providers, empowering patients, and having a lead clinician. CONCLUSION The RtD of sarcoma patients is complex. Increasing awareness of patients and healthcare providers may contribute to shorten the RtD.
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Affiliation(s)
| | - Winette T. A. van der Graaf
- Radboudumc, Nijmegen, The Netherlands
- Antoni van Leeuwenhoekziekenhuis, Amsterdam, The Netherlands
- Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Shane Zaidi
- Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Andrew J. Hayes
- Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Robin L. Jones
- Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Olga Husson
- Antoni van Leeuwenhoekziekenhuis, Amsterdam, The Netherlands
- Institute of Cancer Research, London, United Kingdom
- * E-mail:
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14
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Pedersen LH, Wahlberg A, Cordt M, Schmiegelow K, Dalton SO, Larsen HB. Parent's perspectives of the pathway to diagnosis of childhood cancer: a matter of diagnostic triage. BMC Health Serv Res 2020; 20:969. [PMID: 33092610 PMCID: PMC7584100 DOI: 10.1186/s12913-020-05821-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/14/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Early diagnosis is crucial for the treatment of childhood cancer as it in some cases can prevent progression of disease and improve prognoses. However, childhood cancer can be difficult to diagnose and barriers to early diagnosis are multifactorial. New knowledge about factors influencing the pathway to diagnosis contribute to a deeper understanding of the mechanisms that influence this time span. Qualitative research in the field is sparse but can be expected to lead to additional useful insights that could contribute to efforts shorten time to diagnosis. The purpose of this study was to explore parents' experiences of the pathway to diagnosis in the time between their noticing bodily or behavioural changes and their child's diagnosis. METHODS The study is a qualitative interview study carried out in large Danish hospital. Thirty-two interviews with a total of 46 parents of children with cancer were included for analysis. The children were diagnosed with haematological cancers (n = 17), solid tumours (n = 9) or brain tumours (n = 6). Data were analysed applying the theoretical model of pathways to treatment and an inductive-deductive approach. A revised 'diagnostic triage' model was developed and validated by member checking. RESULTS The pathway to diagnosis was influenced by various factors which we present as consistent parts of a new diagnostic triage model. Each factor impacts the level of urgency assigned to bodily and behavioural changes by parents, general practitioners and specialists. The model of diagnostic triage was developed and validated to understand mechanisms influencing time from the point parents notice changes in their child to diagnosis. The model identifies dynamic movement between parental triage in everyday life and professional triage in a healthcare system, both affecting appraisal and case escalation according to: 1) the nature of bodily and behavioural changes, 2) parental intuition, 3) social relations, 4) professional-child-parent interaction, and 5) specialist-child-parent interaction. CONCLUSIONS Diagnostic triage is a model which explains mechanisms that shape the pathway to diagnosis. It is a contribution aimed at supporting the clinical diagnostic process, that ultimately could ensure more timely testing, referral and diagnosis, and also a novel theoretical framework for future research on diagnostic pathways.
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Affiliation(s)
| | - Ayo Wahlberg
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Marie Cordt
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Danish Cancer Society Research Centre, Survivorship and Inequality in Cancer, Danish Cancer Society, Copenhagen, Denmark.,Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Hanne Bækgaard Larsen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
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15
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Haste A, Lambert M, Sharp L, Thomson R, Sowden S. Patient experiences of the urgent cancer referral pathway-Can the NHS do better? Semi-structured interviews with patients with upper gastrointestinal cancer. Health Expect 2020; 23:1512-1522. [PMID: 32989907 PMCID: PMC7752202 DOI: 10.1111/hex.13136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/28/2020] [Accepted: 09/08/2020] [Indexed: 01/22/2023] Open
Abstract
Background Timeliness is viewed as a key feature of health‐care quality. Internationally, this is challenging. In England, cancer waiting time targets are currently not being met. For example, between 2015 and 2018 only 71% of patients with upper gastrointestinal (UGI) cancer started treatment within the recommended 62 days of referral. Objective We explored patients’ experiences to identify areas for service improvement. Design Semi‐structured interviews were conducted. Setting and participants Twenty patients who were referred through the urgent (two‐week) GP referral route and were within six months of receiving first treatment were recruited. Data analysis Data from the interviews were analysed thematically. Results Four themes were developed: organization of care; diagnosis; support; and views and expectations of the NHS. Patients described cross‐cutting issues such as complex and varied pathways and uncertainty about what would happen next. They felt daunted by the intensity and speed of investigations. They were presented with a recommended course of action rather than options and had little involvement in decision making. They were grateful for care, reluctant to complain and resigned to the status quo. Discussion and conclusions In order to meet patient needs, the NHS needs to improve communication and streamline pathways. Future cancer pathways also need to be designed to support shared decision making, be truly person‐centred and informed by patient experience.
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Affiliation(s)
- Anna Haste
- Department of Psychology, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Mark Lambert
- Public Health England, North East Centre, Newcastle, UK
| | - Linda Sharp
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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16
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Pujadas Botey A, Robson PJ, Hardwicke-Brown AM, Rodehutskors DM, O’Neill BM, Stewart DA. From symptom to cancer diagnosis: Perspectives of patients and family members in Alberta, Canada. PLoS One 2020; 15:e0239374. [PMID: 32970713 PMCID: PMC7514000 DOI: 10.1371/journal.pone.0239374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/07/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Significant intervals from the identification of suspicious symptoms to a definitive diagnosis of cancer are common. Streamlining pathways to diagnosis may increase survival, quality of life post-treatment, and patient experience. Discussions of pathways to diagnosis from the perspective of patients and family members are crucial to advancing cancer diagnosis. AIM To examine the perspectives of a group of patients with cancer and family members in Alberta, Canada, on factors associated with timelines to diagnosis and overall experience. METHODS A qualitative approach was used. In-depth, semi-structured interviews with patients with cancer (n = 18) and patient relatives (n = 5) were conducted and subjected to a thematic analysis. FINDINGS Participants struggled emotionally in the diagnostic period. Relevant to their experience were: potentially avoidable delays, concerns about health status, and misunderstood investigation process. Participants emphasized the importance of their active involvement in the care process, and had unmet supportive care needs. CONCLUSION Psychosocial supports available to potential cancer patients and their families are minimal, and may be important for improved experiences before diagnosis. Access to other patients' lived experiences with the diagnostic process and with cancer, and an enhanced supportive role of family doctors might help improve experiences for patients and families in the interval before receiving a diagnosis of cancer, which may have a significant impact on wellbeing.
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Affiliation(s)
- Anna Pujadas Botey
- Cancer Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
| | - Paula J. Robson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Cancer Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | | | | | - Barbara M. O’Neill
- Cancer Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Douglas A. Stewart
- Cancer Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Departments of Oncology and Medicine, University of Calgary, Calgary, Alberta, Canada
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17
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Bergin RJ, Emery JD, Bollard R, White V. Comparing Pathways to Diagnosis and Treatment for Rural and Urban Patients With Colorectal or Breast Cancer: A Qualitative Study. J Rural Health 2020; 36:517-535. [PMID: 32485017 DOI: 10.1111/jrh.12437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/19/2020] [Accepted: 03/17/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Colorectal cancer patients living in rural areas have poorer outcomes than urban counterparts, but such disparities are not found for breast cancer. Although time to care may contribute to rural-urban disparities, few studies examine patient experiences to understand how and why delays may occur. We compared rural and urban patient experiences of pathways to colorectal or breast cancer diagnosis and treatment in Victoria, Australia. METHODS Semistructured telephone interviews were conducted with 43 patients (49% colorectal; 60% rural, median 7 months postdiagnosis). A framework analysis was applied using the Model of Pathways to Treatment. FINDINGS Rural and urban patients expressed similar attitudes and reasons for prolonged symptom appraisal and help-seeking triggers. However, some rural patients reported long waiting times to see a Primary Care Practitioner (PCP) and perceived greater gatekeeping to diagnostic services. Patient perceptions of the urgency of PCP referral could impact behavior, such as waiting longer to book appointments. Colorectal cancer patients reported more variable types of symptoms, interpretation, and coping strategies, as well as diverse presentation routes and reduced sense of urgency, compared to breast cancer patients. Waiting time for colonoscopy could be long, particularly in the public health system, but mammograms were quickly arranged. CONCLUSIONS Pathway variation was more evident by cancer type than residential location. However, access to primary care and diagnostic services for rural patients with colorectal cancer may be important policy targets. Future research should investigate the impact of diagnostic service accessibility on PCP referral behavior to further understand rural-urban disparities.
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Affiliation(s)
- Rebecca J Bergin
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia.,Department of General Practice and Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Jon D Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Ruth Bollard
- Division of Surgery, Ballarat Health Services, Ballarat, Australia
| | - Victoria White
- School of Psychology, Deakin University, Burwood, Australia.,Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
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18
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Pomey MP, Brouillard P, Ganache I, Lambert L, Boothroyd L, Collette C, Bédard S, Grégoire A, Pelaez S, Demers-Payette O, Goetghebeur M, de Guise M, Roy D. Co-construction of health technology assessment recommendations with patients: An example with cardiac defibrillator replacement. Health Expect 2019; 23:182-192. [PMID: 31691439 PMCID: PMC6978850 DOI: 10.1111/hex.12989] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/29/2019] [Accepted: 10/03/2019] [Indexed: 01/08/2023] Open
Abstract
CONTEXT The National Institute of Excellence in Health and Social Services (INESSS), which functions as the Québec health technology assessment (HTA) agency, tested a new way to engage patients along with health-care professionals in the co-construction of recommendations regarding implantable cardioverter-defibrillator replacement. OBJECTIVE The objective of this article was to describe the process of co-construction of recommendations and to propose methods of building best practices for patient involvement (PI) in HTA. DESIGN Throughout the process, documents were collected and participant observations were made. Individual interviews were conducted with patients, health-care professionals and the INESSS scientific team, from January to March 2018. RESULTS Three committees were established: an expert patient committee to reflect on patient experience literature; an expert health professional committee to reflect on medical literature; and a co-construction committee through which both patients and health-care professionals contributed to develop the recommendations. The expert patients validated and contextualized a literature review produced by the scientific team. This allowed the scientists to consider aspects related to the patient experience and to integrate the feedback from patients into HTA recommendations. The most important factor contributing to a positive PI experience was the structured methodology for selecting patient participants, and a key factor that inhibited the process was a lack of training in PI on the part of the scientific team. CONCLUSIONS This experience demonstrates that it is possible to co-construct recommendations, even for technically complex HTA subjects, through a more democratic process than usual which led to more patient-focused guidance.
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Affiliation(s)
- Marie-Pascale Pomey
- School of Public Health, Université de Montréal, Montreal, Québec, Canada.,Institut national d'excellence en santé et services sociaux, Montreal, Québec, Canada.,Center of Excellence on Partnership with Patients and the Public, Montreal, Québec, Canada.,Centre hospitalier universitaire l'université de Montréal research center (CRCHUM), Montreal, Québec, Canada
| | | | - Isabelle Ganache
- School of Public Health, Université de Montréal, Montreal, Québec, Canada.,Institut national d'excellence en santé et services sociaux, Montreal, Québec, Canada
| | - Laurie Lambert
- School of Public Health, Université de Montréal, Montreal, Québec, Canada
| | - Lucy Boothroyd
- School of Public Health, Université de Montréal, Montreal, Québec, Canada
| | - Caroline Collette
- School of Public Health, Université de Montréal, Montreal, Québec, Canada
| | - Sylvain Bédard
- Center of Excellence on Partnership with Patients and the Public, Montreal, Québec, Canada
| | - Alexandre Grégoire
- Center of Excellence on Partnership with Patients and the Public, Montreal, Québec, Canada
| | | | | | | | - Michèle de Guise
- Institut national d'excellence en santé et services sociaux, Montreal, Québec, Canada
| | - Denis Roy
- Institut national d'excellence en santé et services sociaux, Montreal, Québec, Canada
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19
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McCutchan G, Hiscock J, Hood K, Murchie P, Neal RD, Newton G, Thomas S, Thomas AM, Brain K. Engaging high-risk groups in early lung cancer diagnosis: a qualitative study of symptom presentation and intervention preferences among the UK's most deprived communities. BMJ Open 2019; 9:e025902. [PMID: 31122972 PMCID: PMC6538016 DOI: 10.1136/bmjopen-2018-025902] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/18/2019] [Accepted: 03/08/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES People at high-risk for lung cancer-current/former smokers, aged 40+ years, with serious lung comorbidity (ie, chronic obstructive pulmonary disease) and living in highly deprived areas-are more likely to delay symptom presentation. This qualitative study aimed to understand the influences on early presentation with lung cancer symptoms in high-risk individuals and intervention preferences. METHODS Semi-structured qualitative interviews with 37 high-risk individuals (without a cancer diagnosis), identified through seven GP practices in socioeconomically deprived areas of England, Scotland and Wales (most deprived 20%). A symptom attribution task was used to explore lung symptom perception and help seeking, developed using Leventhal's Common Sense Model. Four focus groups with 16 high-risk individuals and 12 local stakeholders (healthcare professionals and community partners) were conducted to explore preferences for an intervention to promote early lung cancer symptom presentation. Data were synthesised using Framework analysis. RESULTS Individual and area level indicators of deprivation confirmed that interview participants were highly deprived. Interviews. Preoccupation with managing 'treatable' short-term conditions (chest infections), led to avoidance of acting on 'inevitable and incurable' long-term conditions (lung cancer). Feeling judged and unworthy of medical help because of their perceived social standing or lifestyle deterred medical help seeking, particularly when difficult life circumstances and traumatic events led to tobacco and alcohol addiction. Focus groups. Participants recommended multifaceted interventions in community venues, with information about lung cancer symptoms and the benefits of early diagnosis, led by a trained and non-judgemental facilitator. CONCLUSIONS This study was novel in engaging a high-risk population to gain an in-depth understanding of the broader contextual influences on lung cancer symptom presentation. Perceived lack of health service entitlement and complex lives facilitated avoidance of recognising and presenting with lung cancer symptoms. Community-based interventions have the potential to empower disadvantaged populations to seek medical help for lung symptoms.
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Affiliation(s)
- Grace McCutchan
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Julia Hiscock
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Kerenza Hood
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
| | - Peter Murchie
- Division of Applied Health Science, University of Aberdeen, Aberdeen, UK
| | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Gareth Newton
- Division of Population Medicine, Patient and Public Involvement, Cardiff University, Cardiff, UK
| | - Sara Thomas
- Cwm Taf Morgannwg Public Health Team, Public Health Wales, Merthyr Tydfil, UK
| | - Ann Maria Thomas
- Division of Population Medicine, Patient and Public Involvement, Cardiff University, Cardiff, UK
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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