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Fernández-Martínez NF, Petrova D, Špacírová Z, Barrios-Rodríguez R, Pérez-Sayáns M, Martín-delosReyes LM, Pérez-Gómez B, Rodríguez-Barranco M, Sánchez MJ. The duration of intervals on the oral cancer care pathway and implications for survival: a systematic review and meta-analysis. Front Public Health 2023; 11:1183244. [PMID: 37614446 PMCID: PMC10442570 DOI: 10.3389/fpubh.2023.1183244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/19/2023] [Indexed: 08/25/2023] Open
Abstract
Introduction Previous studies measuring intervals on the oral cancer care pathway have been heterogenous, showing mixed results with regard to patient outcomes. The aims of this research were (1) to calculate pooled meta-analytic estimates for the duration of the patient, diagnostic and treatment intervals in oral cancer, considering the income level of the country, and (2) to review the evidence on the relationship of these three intervals with tumor stage at diagnosis and survival. Materials and methods We conducted a systematic review with meta-analysis following PRISMA 2020 guidelines (pre-registered protocol CRD42020200752). Following the Aarhus statement, studies were eligible if they reported data on the length of the patient (first symptom to first presentation to a healthcare professional), diagnostic (first presentation to diagnosis), or treatment (diagnosis to start of treatment) intervals in adult patients diagnosed with primary oral cancer. The risk of bias was assessed with the Aarhus checklist. Results Twenty-eight studies reporting on 30,845 patients met the inclusion criteria. The pooled median duration of the patient interval was 47 days (95% CI = 31-73), k = 18, of the diagnosis interval 35 days (95% CI = 21-38), k = 11, and of the treatment interval 30 days (95% CI = 23-53), k = 19. In lower-income countries, the patient and treatment intervals were significantly longer, and longer patient intervals were related to later stage at diagnosis. In studies with a lower risk of bias from high-income countries, longer treatment intervals were associated with lower survival rates. Conclusion Interval duration on the oral cancer care pathway is influenced by the socio-economic context and may have implications for patient outcomes.
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Affiliation(s)
- Nicolás Francisco Fernández-Martínez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Zuzana Špacírová
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Rocío Barrios-Rodríguez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Mario Pérez-Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
- ORALRES Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Luis Miguel Martín-delosReyes
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Beatriz Pérez-Gómez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Epidemiology for Chronic Diseases, National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - María José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
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2
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Black GB, Boswell L, Harris J, Whitaker KL. What causes delays in diagnosing blood cancers? A rapid review of the evidence. Prim Health Care Res Dev 2023; 24:e26. [PMID: 37039465 PMCID: PMC10156470 DOI: 10.1017/s1463423623000129] [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: 06/20/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVE We undertook a rapid review of literature relating to the diagnosis of blood cancers, to find out what factors contribute to delays in diagnosis, including symptom recognition, appraisal and help-seeking behaviours. METHODS We used rapid review methodology following Tricco et al. to synthesise current literature from two electronic databases. We searched for studies about symptom appraisal help-seeking for all blood cancers published between 2001 and 2021, written in English. RESULTS Fifteen studies were included in the review, of which 10 were published in the United Kingdom. We found a number of factors associated with delays in blood cancer diagnosis. These included patient factors such as gender, age and ethnicity, as well as health system factors such as poor communication and seeing a locum clinician in primary care. A narrative synthesis of the evidence produced four types of symptom interpretation by patients: (1) symptoms compatible with normal state of health, (2) event-linked problems, (3) mild or chronic illness and (4) non-specific unwell state. These four interpretations were linked to different help-seeking behaviours. After seeking help, patients often experienced delays due to healthcare professionals' (HCPs') non-serious interpretation of symptoms, misleading blood tests, discontinuity of care and other barriers in the diagnostic pathway. CONCLUSION Blood cancers are difficult to diagnose due to non-specific heterogeneous symptoms, and this is reflected in how those symptoms are interpreted by patients and managed by HCPs. It is important to understand how different interpretations affect delays in help-seeking, and what HCPs can do to support timely follow-up for patients.
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Affiliation(s)
- Georgia B. Black
- Reader in Applied Health Research, Wolfson Institute of Population Health,
Queen Mary University of London, London,
UK
| | - Laura Boswell
- PhD student, School of Health Sciences, University of
Surrey, Guildford, UK
| | - Jenny Harris
- Senior Lecturer in Cancer Care, School of Health Sciences,
University of Surrey, Guildford,
UK
| | - Katriina L. Whitaker
- Professor of Psychology and Lead for Cancer Care, School of Health
Sciences, University of Surrey, Guildford,
UK
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3
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Petrova D, Pollán M, Garcia-Retamero R, Rodríguez-Barranco M, Catena A, Castillo Portellano L, Sánchez MJ. Cancer awareness in older adults: Results from the Spanish Onco-barometer cross-sectional survey. Int J Nurs Stud 2023; 140:104466. [PMID: 36871541 DOI: 10.1016/j.ijnurstu.2023.104466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND About half of all cancers are diagnosed in adults older than 65, making them the age group at highest risk of developing this disease. Nurses from different specialties can support individuals and communities in the prevention and early detection of cancer and should be aware of the common knowledge gaps and perceived barriers among older adults. OBJECTIVES The goal of the current research was to investigate personal characteristics, perceived barriers, and beliefs related to cancer awareness in older adults, with a special focus on perceptions about the influence of cancer risk factors, knowledge of cancer symptoms, and anticipated help-seeking. DESIGN Descriptive cross-sectional study. PARTICIPANTS Participants were 1213 older adults (≥65 years old) from the representative national Onco-barometer survey conducted in 2020 in Spain. METHODS Questions on the perceived influence of cancer risk factors, knowledge of cancer symptoms, and the Spanish version of the Awareness and Beliefs about Cancer (ABC) questionnaire were administered in computer-assisted telephone interviews. RESULTS Knowledge of cancer risk factors and symptoms was strongly related to personal characteristics and was limited among males and older individuals. Respondents from lower socio-economic background recognized fewer cancer symptoms. Having personal or family history of cancer had opposite effects on cancer awareness: It was related to more accurate symptom knowledge but also to lower perceptions about the influence of risk factors and more delayed help-seeking. Anticipated help-seeking times were strongly influenced by perceived barriers to help-seeking and beliefs about cancer. Worry about wasting the doctor's time (48% increase, 95% CI [25%-75%]), about what the doctor might find (21% increase [3%-43%]) and not having enough time to go to the doctor (30% increase [5%-60%]) were related to more delayed help-seeking intentions. In contrast, beliefs that reflected higher perceived seriousness of a potential cancer diagnosis were related to shorter anticipated help-seeking times (19% decrease [5%-33%]). CONCLUSIONS These results suggest that older adults could benefit from interventions informing them about how to reduce their cancer risk and addressing emotional barriers and beliefs associated with help-seeking delays. Nurses can contribute to educating this vulnerable group and are in a unique position to address some barriers to help-seeking. STUDY REGISTRATION Not registered.
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Affiliation(s)
- Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública (EASP), Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Marina Pollán
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; National Center for Epidemiology, Health Institute Carlos III, Madrid, Spain
| | | | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública (EASP), Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Lucia Castillo Portellano
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; University Hospital Virgen de las Nieves, Granada, Spain
| | - Maria-José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública (EASP), Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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4
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Petrova D, Garrido D, Špacírová Z, Fernández-Martínez NF, Ivanova G, Rodríguez-Barranco M, Pollán M, Barrios-Rodríguez R, Sánchez MJ. Duration of the patient interval in breast cancer and factors associated with longer delays in low-and middle-income countries: A systematic review with meta-analysis. Psychooncology 2023; 32:13-24. [PMID: 36345154 PMCID: PMC10100001 DOI: 10.1002/pon.6064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/02/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Breast cancer survival is lower in low- and middle-income countries (LMICs) partially due to many women being diagnosed with late-stage disease. The patient interval refers to the time elapsed between the detection of symptoms and the first consultation with a healthcare provider and is considered one of the core indicators for early diagnosis and treatment. The goal of the current research was to conduct a meta-analysis of the duration of the patient interval in LMICs and investigate the socio-demographic and socio-cultural factors related to longer delays in presentation. METHODS We conducted a systematic review with meta-analysis (pre-registered protocol CRD42020200752). We searched seven information sources (2009-2022) and included 50 articles reporting the duration of patient intervals for 18,014 breast cancer patients residing in LMICs. RESULTS The longest patient intervals were reported in studies from the Middle East (3-4 months), followed by South-East Asia (2 months), Africa (1-2 months), Latin America (1 month), and Eastern Europe (1 month). Older age, not being married, lower socio-economic status, illiteracy, low knowledge about cancer, disregarding symptoms or not attributing them to cancer, fear, negative beliefs about cancer, and low social support were related to longer delays across most regions. Longer delays were also related to use of alternative medicine in the Middle East, South-East Asia, and Africa and distrust in the healthcare system in Eastern Europe. CONCLUSIONS There is large variation in the duration of patient intervals across LMICs in different geographical regions. Patient intervals should be reduced and, for this purpose, it is important to explore their determinants taking into account the social, cultural, and economic context.
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Affiliation(s)
- Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Dunia Garrido
- Department of Developmental and Educational Psychology, University of Granada, Granada, Spain
| | - Zuzana Špacírová
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Nicolás Francisco Fernández-Martínez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Interlevel Clinical Management Unit for Prevention, Promotion and Health Surveillance, Reina Sofía University Hospital, Córdoba, Spain
| | - Ganka Ivanova
- Department of Applied Psychology, College of Education, Social Sciences and Humanities, Al-Ain University, Abu Dhabi, United Arab Emirates
| | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Marina Pollán
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,National Center for Epidemiology, Health Institute Carlos III, Madrid, Spain
| | - Rocío Barrios-Rodríguez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Maria José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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5
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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.
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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
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6
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George S. Being sick to a cancer patient: pathways of delay in help seeking and diagnosis of cancer in India. JOURNAL OF SOCIAL AND ECONOMIC DEVELOPMENT 2022; 25:52-69. [PMID: 36466373 PMCID: PMC9685046 DOI: 10.1007/s40847-022-00221-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 06/03/2023]
Abstract
There is evidence that cancer mortality and morbidity could be reduced when the disease is diagnosed and treated at an early stage. The paper examines the pathways of delay of cancer diagnosis in an Indian setting. It draws on a qualitative study conducted among cancer survivors and family members of cancer patients in the city of Bengaluru, South India. The results show that a substantial part of the delay occurred at the stage of initial formal help seeking wherein patient and family-led, disease-related and systemic factors together played a major role. Patient-led factors included trivialisation and normalisation of symptoms as part of general fatigue and aging; unrealistic risk perceptions that linked causality of cancer merely to heredity and behavioural risk factors; fear of being diagnosed as cancer patient; gender related reasons including family's gender performance expectation, lower agency of women to seek help and lower prioratisation of women's health in the household and access related issues including financial constraints and unavailability of specialised hospitals nearby. Disease-related factors included the presence of comorbidity, cancer's mimicking of symptoms of other diseases and absence of distinguishable symptoms at the initial stage for certain types of cancers. The practitioner-led and system-led factors such as trivialisation of symptoms by general practitioners, non cancer-specific referrals, and lack of cancer screening facilities accounted for a major part of delay after the formal help seeking. The paper argues that the mere knowledge of cancer symptoms did not always lead to early diagnosis due to the interplay of these factors. The ongoing cancer prevention and control interventions in India need to be informed of these micro level factors while developing strategies to prevent avoidable delays in cancer diagnosis.
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Affiliation(s)
- Sobin George
- Centre for the Study of Social Change and Development, Institute for Social and Economic Change, Bengaluru, India
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7
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Petrova D, Špacírová Z, Fernández-Martínez NF, Ching-López A, Garrido D, Rodríguez-Barranco M, Pollán M, Redondo-Sánchez D, Espina C, Higueras-Callejón C, Sánchez MJ. The patient, diagnostic, and treatment intervals in adult patients with cancer from high- and lower-income countries: A systematic review and meta-analysis. PLoS Med 2022; 19:e1004110. [PMID: 36264841 PMCID: PMC9584443 DOI: 10.1371/journal.pmed.1004110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 09/15/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Longer time intervals to diagnosis and treatment are associated with worse survival for various types of cancer. The patient, diagnostic, and treatment intervals are considered core indicators for early diagnosis and treatment. This review estimated the median duration of these intervals for various types of cancer and compared it across high- and lower-income countries. METHODS AND FINDINGS We conducted a systematic review with meta-analysis (prospectively registered protocol CRD42020200752). Three databases (MEDLINE, Embase, and Web of Science) and information sources including grey literature (Google Scholar, OpenGrey, EThOS, ProQuest Dissertations & Theses) were searched. Eligible articles were published during 2009 to 2022 and reported the duration of the following intervals in adult patients diagnosed with primary symptomatic cancer: patient interval (from the onset of symptoms to first presentation to a healthcare professional), diagnostic interval (from first presentation to diagnosis), and treatment interval (from diagnosis to treatment start). Interval duration was recorded in days and study medians were combined in a pooled estimate with 95% confidence intervals (CIs). The methodological quality of studies was assessed using the Aarhus checklist. A total of 410 articles representing 68 countries and reporting on 5,537,594 patients were included. The majority of articles reported data from high-income countries (n = 294, 72%), with 116 (28%) reporting data from lower-income countries. Pooled meta-analytic estimates were possible for 38 types of cancer. The majority of studies were conducted on patients with breast, lung, colorectal, and head and neck cancer. In studies from high-income countries, pooled median patient intervals generally did not exceed a month for most cancers. However, in studies from lower-income countries, patient intervals were consistently 1.5 to 4 times longer for almost all cancer sites. The majority of data on the diagnostic and treatment intervals came from high-income countries. Across both high- and lower-income countries, the longest diagnostic intervals were observed for hematological (71 days [95% CI 52 to 85], e.g., myelomas (83 days [47 to 145])), genitourinary (58 days [50 to 77], e.g., prostate (85 days [57 to 112])), and digestive/gastrointestinal (57 days [45 to 67], e.g., colorectal (63 days [48 to 78])) cancers. Similarly, the longest treatment intervals were observed for genitourinary (57 days [45 to 66], e.g., prostate (75 days [61 to 87])) and gynecological (46 days [38 to 54], e.g., cervical (69 days [45 to 108]) cancers. In studies from high-income countries, the implementation of cancer-directed policies was associated with shorter patient and diagnostic intervals for several cancers. This review included a large number of studies conducted worldwide but is limited by survivor bias and the inherent complexity and many possible biases in the measurement of time points and intervals in the cancer treatment pathway. In addition, the subintervals that compose the diagnostic interval (e.g., primary care interval, referral to diagnosis interval) were not considered. CONCLUSIONS These results identify the cancers where diagnosis and treatment initiation may take the longest and reveal the extent of global disparities in early diagnosis and treatment. Efforts should be made to reduce help-seeking times for cancer symptoms in lower-income countries. Estimates for the diagnostic and treatment intervals came mostly from high-income countries that have powerful health information systems in place to record such information.
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Affiliation(s)
- Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Zuzana Špacírová
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Nicolás Francisco Fernández-Martínez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Interlevel Clinical Management Unit for Prevention, Promotion and Health Surveillance, Reina Sofía University Hospital, Córdoba, Spain
| | - Ana Ching-López
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Dunia Garrido
- Department of Developmental and Educational Psychology, University of Granada, Granada, Spain
| | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Marina Pollán
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- National Center for Epidemiology, Health Institute Carlos III, Madrid, Spain
| | - Daniel Redondo-Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Carolina Espina
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | | | - Maria José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
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8
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Anaba UC, Johansson EW, Abegunde D, Adoyi G, Umar-Farouk O, Abdu-Aguye S, Hewett PC, Hutchinson PL. The role of maternal ideations on breastfeeding practices in northwestern Nigeria: a cross-section study. Int Breastfeed J 2022; 17:63. [PMID: 36050774 PMCID: PMC9438163 DOI: 10.1186/s13006-022-00500-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background Early initiation of breastfeeding within the first hour of birth and exclusive breastfeeding (EBF) for the first six months of life are beneficial for child survival and long-term health. Yet breastfeeding rates remain sub-optimal in Northwestern Nigeria, and such practices are often influenced by complex psychosocial factors at cognitive, social and emotional levels. To understand these influences, we developed a set of breastfeeding-related ideational factors and quantitatively examined their relationship with early initiation of breastfeeding and EBF practices. Methods A cross‐sectional population‐based survey was conducted in Kebbi, Sokoto, and Zamfara states from September–October 2019. A random sample of 3039 women with a child under-2 years was obtained. Respondents were asked about the two main outcomes, early initiation of breastfeeding and EBF, as well as breastfeeding-related ideations according to the Ideation Model of Strategic Communication and Behavior Change. Average marginal effects were estimated from mixed-effects logistic regression models adjusted for ideational and socio-demographic variables. Results Among 3039 women with a child under 2 years of age, 42.1% (95% CI 35.1%, 49.4%) practiced early initiation of breastfeeding, while 37.5% (95% CI 29.8%, 46.0%) out of 721 infants aged 0–5 months were exclusively breastfed. Women who knew early initiation of breastfeeding was protective of newborn health had 7.9 percentage points (pp) [95% CI 3.9, 11.9] higher likelihood of early initiation of breastfeeding practice than those who did not know. Women who believed colostrum was harmful had 8.4 pp lower likelihood of early initiation of breastfeeding (95% CI -12.4, -4.3) and EBF (95% CI -15.7%, -1.0%) than those without that belief. We found higher likelihood of early initiation of breastfeeding (5.1 pp, 95% CI 0.8%, 9.4%) and EBF (13.3 pp, 95% CI 5.0%, 22.0%) among women who knew at least one benefit of breastfeeding compared to those who did not know. Knowing the timing for introducing complementary foods andself-efficacy to practice EBF were also significantly associated with EBF practices. Conclusion Ideational metrics provide significant insights for SBC programs aiming to change and improve health behaviors, including breastfeeding practices, Various cognitive, emotional and social domains played a significant role in women’s breastfeeding decisions. Maternal knowledge about the benefits of breastfeeding to the mother (cognitive), knowledge of the appropriate time to introduce complementary foods (cognitive), beliefs on colostrum (cognitive), self-efficacy to breastfeed (emotional) and perceived social norms (social) are among the most important ideations for SBC programs to target to increase early initiation of breastfeeding and EBF rates in northwestern Nigeria.
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Affiliation(s)
- Udochisom C Anaba
- Breakthrough RESEARCH/Nigeria, Plot 839 Idris Ibrahim Crescent, Jabi, Abuja, Nigeria. .,Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA.
| | - Emily White Johansson
- Breakthrough RESEARCH/Nigeria, Plot 839 Idris Ibrahim Crescent, Jabi, Abuja, Nigeria.,Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | - Dele Abegunde
- Breakthrough RESEARCH/Nigeria, Plot 839 Idris Ibrahim Crescent, Jabi, Abuja, Nigeria.,Formerly Population Council, Washington DC, USA
| | - Gloria Adoyi
- Breakthrough ACTION/Nigeria, Abuja, Nigeria.,Save the Children, Abuja, Nigeria
| | - Olayinka Umar-Farouk
- Breakthrough ACTION/Nigeria, Abuja, Nigeria.,Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Shittu Abdu-Aguye
- Breakthrough ACTION/Nigeria, Abuja, Nigeria.,Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | | | - Paul L Hutchinson
- Breakthrough RESEARCH/Nigeria, Plot 839 Idris Ibrahim Crescent, Jabi, Abuja, Nigeria.,Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
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9
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Xiang L, Yoon S, Low AHL, Leung YY, Fong W, Lau TC, Koh DR, Thumboo J. Approaches to improving symptom appraisal: a systematic literature review. BMJ Open 2022; 12:e064521. [PMID: 35998970 PMCID: PMC9403152 DOI: 10.1136/bmjopen-2022-064521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Poor symptom appraisal (detection, interpretation and response to symptoms) plays a major role in prolonged prediagnosis interval in various health conditions. Theories and models have been proposed to study the symptom appraisal process but how they could be employed to improve symptom appraisal remains unclear. We therefore aimed to review approaches to improving symptom appraisal in the literature and to develop a theoretical framework that could guide the development of approaches to improving symptom appraisal among individuals in the general population. DESIGN Systematic review. DATA SOURCES Medline, Web of Science, PsycINFO, Embase, CINAHL and Scopus were searched from inception to 30 March 2021. ELIGIBILITY CRITERIA We included original articles in English in which approaches to improve the detection, interpretation or response to symptoms for symptomatic individuals were described. We excluded articles in which approaches were developed to improve symptom appraisal among healthcare professionals. DATA EXTRACTION AND SYNTHESIS A predefined data extraction form was used to extract the development, characteristics and evaluation of approaches to improving symptom appraisal. This formed the basis for the narrative synthesis. RESULTS Of 19 046 publications identified from the literature search, 112 were selected for full-text review and 29 approaches comprising provision of knowledge of symptoms/signs and additional components (eg, symptom self-examination and comparison) for symptom appraisal were included in the synthesis. Less than half (41.4%) of these approaches were developed based on theories/models. Interestingly, despite the variety of theories/models adopted in developing these approaches, the components of these approaches were similar. CONCLUSION Symptom appraisal is an essential process in a patient's journey that can be targeted to facilitate early diagnosis but is largely unstudied. Building on the literature, we proposed a theoretical framework and approaches to improving symptom appraisal. This could facilitate early identification of a variety of health conditions in the general population. TRIAL REGISTRATION NUMBER CRD42021279500.
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Affiliation(s)
- Ling Xiang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Andrea H L Low
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Tang Ching Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, National University Hospital, Singapore
| | - Dow Rhoon Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, National University Hospital, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore
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10
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Oshiro M, Kamizato M, Jahana S. Factors related to help-seeking for cancer medical care among people living in rural areas: a scoping review. BMC Health Serv Res 2022; 22:836. [PMID: 35765056 PMCID: PMC9241203 DOI: 10.1186/s12913-022-08205-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
Despite the importance of timely diagnosis and access to treatment, previous studies have not adequately explored help-seeking behavior in cancer treatment among rural and remote residents. The barriers preventing help-seeking behavior also remain unclear. To address this research gap, this study conducted a scoping review to suggest a framework for eliminating barriers and facilitating help-seeking for cancer treatment among rural and remote residents. To conduct the scoping review, three English medical databases (PubMed, MEDLINE, and CINAHL) were examined for the keywords "rural," "remote," "cancer," and "help-seeking." The research objectives and study designs, participants, and excerpts describing help-seeking of the selected papers were recorded in a data charting form. Descriptions of help-seeking behavior were organized and summarized according to their meaning and integrated into factors using thematic analysis. All extracted factors related to help-seeking were sorted into four main themes according to the Ecological Model of Health Behavior, the theoretical lens for this scoping review: (1) Intrapersonal; (2) Interpersonal; (3) Groups, culture, and organizations; and (4) Policy/environment. Factors were categorized as barriers and facilitators of help-seeking. A total of 13 papers were analyzed. Intrapersonal factors such as self-reliance, symptom appraisal, and fatalism, were identified as barriers to help-seeking, whereas presentation of abnormal and serious symptoms facilitated help-seeking. Interpersonal factors such as lack of understanding of family members, influence of surrounding people, role obligations, and lack of trust in experts hindered help-seeking, whereas understanding from surrounding people such as family and friends, promoted help-seeking. Groups, cultural, and organizational factors such as prejudice, social stigma, shame, lack of anonymity, and social norms acted as barriers to help-seeking. Policy-related barriers to help-seeking included lack of medical services and physical distance from medical institutions, leading to a time burden. The study discussed the identified factors from a rural context. Future studies should consider the identified barriers and facilitators according to the four main themes in rural areas when formulating interventions to promote help-seeking. Our findings can offer a theoretical foundation to develop actionable policies, preventive strategies, and relevant interventional tools that may facilitate oncological service utilization in rural areas.
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Affiliation(s)
- Mariko Oshiro
- Department of Nursing, Okinawa Prefectural College of Nursing, Yogi 1-24-1, Naha City, Okinawa, 902-8513, Japan.
| | - Midori Kamizato
- Department of Nursing, Okinawa Prefectural College of Nursing, Yogi 1-24-1, Naha City, Okinawa, 902-8513, Japan
| | - Sayuri Jahana
- Department of Nursing, Okinawa Prefectural College of Nursing, Yogi 1-24-1, Naha City, Okinawa, 902-8513, Japan
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11
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Jones D, Di Martino E, Bradley SH, Essang B, Hemphill S, Wright JM, Renzi C, Surr C, Clegg A, Neal R. Factors influencing symptom appraisal and help-seeking of older adults with possible cancer: a mixed-methods systematic review. Br J Gen Pract 2022; 72:BJGP.2021.0655. [PMID: 35995576 PMCID: PMC9423047 DOI: 10.3399/bjgp.2021.0655] [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: 11/26/2021] [Accepted: 05/24/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The cancer burden falls predominantly on older (≥65 years) adults. Prompt presentation to primary care with cancer symptoms could result in earlier diagnosis. However, patient symptom appraisal and help-seeking decisions involving cancer symptoms are complex and may be further complicated in older adults. AIM To explore the effect of older age on patients' appraisal of possible cancer symptoms and their decision to seek help for these symptoms. DESIGN AND SETTING Mixed-methods systematic review. METHOD MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Library, Web of Science Core Collection, ASSIA, the ISRCTN registry, and the National Institute for Health and Care Excellence were searched for studies on symptom appraisal and help-seeking decisions for cancer symptoms by adults aged ≥65 years. Studies were analysed using thematic synthesis and according to the Synthesis Without Meta-Analysis guidelines. RESULTS Eighty studies were included with a total of 32 995 participants. Studies suggested a possible association between increasing age and prolonged symptom appraisal interval. Reduced knowledge of cancer symptoms and differences in symptom interpretation may contribute to this prolonged interval. In contrast, in the current study a possible association was found between increasing age and prompt help-seeking. Themes affecting help-seeking in older adults included the influence of family and carers, competing priorities, fear, embarrassment, fatalism, comorbidities, a desire to avoid doctors, a perceived need to not waste doctors' time, and patient self-management of symptoms. CONCLUSION This review suggests that increasing age is associated with delayed cancer symptom appraisal. When symptoms are recognised as potentially serious, increasing age was associated with prompt help-seeking although other factors could prolong this. Policymakers, charities, and GPs should aim to ensure older adults are able to recognise potential symptoms of cancer and seek help promptly.
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Affiliation(s)
- Daniel Jones
- Leeds Institute of Health Sciences, University of Leeds, Leeds
| | | | | | - Blessing Essang
- Leeds Institute of Health Sciences, University of Leeds, Leeds
| | - Scott Hemphill
- Leeds Institute of Health Sciences, University of Leeds, Leeds
| | - Judy M Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds
| | | | | | - Andrew Clegg
- Academic Unit for Ageing & Stroke Research, University of Leeds, Leeds
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12
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Understanding the Experience of Canadian Women Living with Ovarian Cancer through the Every Woman Study TM. Curr Oncol 2022; 29:3318-3340. [PMID: 35621661 PMCID: PMC9139742 DOI: 10.3390/curroncol29050271] [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: 03/29/2022] [Revised: 04/30/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Abstract
The Every Woman StudyTM: Canadian Edition is the most comprehensive study to date exploring patient-reported experiences of ovarian cancer (OC) on a national scale. An online survey conducted in Fall 2020 included individuals diagnosed with OC in Canada, reporting responses from 557 women from 11 Canadian provinces/territories. Median age at diagnosis was 54 (11−80), 61% were diagnosed between 2016−2020, 59% were stage III/IV and all subtypes of OC were represented. Overall, 23% had a family history of OC, 75% had genetic testing and 19% reported having a BRCA1/2 mutation. Most (87%) had symptoms prior to diagnosis. A timely diagnosis of OC (≤3 months from first presentation with symptoms) was predicted by age (>50) or abdominal pain/persistent bloating as the primary symptom. Predictors of an acute diagnosis (<1 month) included region, ER/urgent care doctor as first healthcare provider or stage III/IV disease. Regional differences in genetic testing, treatments and clinical trial participation were also noted. Respondents cited substantial physical, emotional, practical and financial impacts of an OC diagnosis. Our national survey has revealed differences in the pathway to diagnosis and post-diagnostic care among Canadian women with OC, with region, initial healthcare provider, specific symptoms and age playing key roles. We have identified many opportunities to improve both clinical and supportive care of OC patients across the country.
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13
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Eberhardt J, Bright CJ, Gildea C, Adeghe O, Mak V, Paley L, Ling J, Elliss-Brookes L. Impact of the third national 'Be Clear on Cancer' Breast Cancer in Women over 70 Campaign on general practitioner attendance and referral, diagnosis rates and prevalence awareness. Eur J Cancer Care (Engl) 2022; 31:e13583. [PMID: 35384107 PMCID: PMC9285744 DOI: 10.1111/ecc.13583] [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: 06/22/2021] [Revised: 12/02/2021] [Accepted: 03/22/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE More than a third of women diagnosed with breast cancer in England, and over half of those who die from it, are over 70. The Be Clear on Cancer Breast Cancer in Women over 70 Campaign, running three times, 2014-2018, aimed to promote early diagnosis of breast cancer in England by raising symptom awareness and encouraging women to see their general practitioner (GP) without delay. We sought to establish whether the third campaign had successfully met its aims. METHODS Metrics covering the patient pathway, including symptom awareness, attending a GP practice with symptoms, urgent GP referral, diagnosis and stage of cancer, were assessed using national cancer databases and two household surveys. RESULTS The third campaign was associated with an increase in urgent cancer referrals, and therefore mammograms and ultrasounds performed. This was associated with an increase in breast cancers diagnosed. There was a delayed effect on GP attendances. Awareness of breast cancer prevalence for the 70-and-over age group improved. Impact on these metrics diminished across successive campaigns. CONCLUSIONS Future campaigns should focus on harder-to-reach women and include GPs as targets as this campaign showed a potential to affect referral behaviour.
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Affiliation(s)
- Judith Eberhardt
- Department of Psychology, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Chloe J Bright
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Carolyn Gildea
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Osa Adeghe
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Vivian Mak
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Lizz Paley
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Jonathan Ling
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Lucy Elliss-Brookes
- National Cancer Registration and Analysis Service, Public Health England, London, UK
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14
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Fish JA, Prichard I, Ettridge K, Grunfeld EA, Wilson C. Predicting men’s intentions to seek help for cancer symptoms: a comparison of the Theory of Planned Behaviour and the Health Belief Model. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2022. [DOI: 10.1080/00049530.2022.2039042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jennifer A. Fish
- Flinders Health & Medical Research Institute, College of Medicine & Public Health, Flinders University, Adelaide, Australia
- Rosemary Bryant Ao Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Ivanka Prichard
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Kerry Ettridge
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Health Policy Centre, South Australian Health & Medical Research Institute, Adelaide, Australia
| | | | - Carlene Wilson
- Flinders Health & Medical Research Institute, College of Medicine & Public Health, Flinders University, Adelaide, Australia
- Olivia Newton John Cancer and Wellness Research Centre, Austin Health, Heidelberg, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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15
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McCutchan G, Weiss B, Quinn-Scoggins H, Dao A, Downs T, Deng Y, Ho H, Trung L, Emery J, Brain K. Psychosocial influences on help-seeking behaviour for cancer in low-income and lower middle-income countries: a mixed-methods systematic review. BMJ Glob Health 2021; 6:bmjgh-2020-004213. [PMID: 33531348 PMCID: PMC7868297 DOI: 10.1136/bmjgh-2020-004213] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction Starting cancer treatment early can improve outcomes. Psychosocial factors influencing patients’ medical help-seeking decisions may be particularly important in low and lower middle-income countries (LMIC) where cancer outcomes are poor. Comprehensive review evidence is needed to understand the psychosocial influences on medical help-seeking for cancer symptoms, attendance for diagnosis and starting cancer treatment. Methods Mixed-methods systematic review registered on PROSPERO (CRD42018099057). Peer-reviewed databases were searched until April 2020 for studies assessing patient-related barriers and facilitators to medical help-seeking for cancer symptoms, diagnosis and treatment in adults (18+ years) living in LMICs. Quality of included studies was assessed using the Critical Appraisal Skills Programme tool. Data were synthesised using meta-analytic techniques, meta-ethnography or narrative synthesis as appropriate. Results Of 3963 studies identified, 64 were included. In quantitative studies, use of traditional, complementary and alternative medicine (TCAM) was associated with 3.60 higher odds of prolonged medical help-seeking (95% CI 2.06 to 5.14). Qualitative studies suggested that use of TCAM was a key barrier to medical help-seeking in LMICs, and was influenced by causal beliefs, cultural norms and a preference to avoid biomedical treatment. Women face particular barriers, such as needing family permission for help-seeking, and higher stigma for cancer treatment. Additional psychosocial barriers included: shame and stigma associated with cancer such as fear of social rejection (eg, divorce/disownment); limited knowledge of cancer and associated symptoms; and financial and access barriers associated with travel and appointments. Conclusion Due to variable quality of studies, future evaluations would benefit from using validated measures and robust study designs. The use of TCAM and gender influences appear to be important barriers to help-seeking in LMIC. Cancer awareness campaigns developed with LMIC communities need to address cultural influences on medical help-seeking behaviour.
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Affiliation(s)
- Grace McCutchan
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK .,Wales Cancer Research Centre, Cardiff University, Cardiff, UK
| | - Bahr Weiss
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Harriet Quinn-Scoggins
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.,PRIME Centre Wales, Cardiff University, Cardiff, UK
| | - Anh Dao
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Tom Downs
- Department of Acute Medicine, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK
| | - Yunfeng Deng
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Ha Ho
- Center for Research, Information and Services in Psychology, Vietnam National University, Hanoi, Vietnam
| | - Lam Trung
- Danang Psychiatric Hospital, Da Nang, Vietnam
| | - Jon Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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16
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Petrova D, Pollán M, Rodriguez-Barranco M, Garrido D, Borrás JM, Sánchez MJ. Anticipated help-seeking for cancer symptoms before and after the coronavirus pandemic: results from the Onco-barometer population survey in Spain. Br J Cancer 2021; 124:2017-2025. [PMID: 33854210 PMCID: PMC8044659 DOI: 10.1038/s41416-021-01382-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/11/2021] [Accepted: 03/25/2021] [Indexed: 12/21/2022] Open
Abstract
Background The patient interval—the time patients wait before consulting their physician after noticing cancer symptoms—contributes to diagnostic delays. We compared anticipated help-seeking times for cancer symptoms and perceived barriers to help-seeking before and after the coronavirus pandemic. Methods Two waves (pre-Coronavirus: February 2020, N = 3269; and post-Coronavirus: August 2020, N = 1500) of the Spanish Onco-barometer population survey were compared. The international ABC instrument was administered. Pre–post comparisons were performed using multiple logistic and Poisson regression models. Results There was a consistent and significant increase in anticipated times to help-seeking for 12 of 13 cancer symptoms, with the largest increases for breast changes (OR = 1.54, 95% CI 1.22–1–96) and unexplained bleeding (OR = 1.50, 1.26–1.79). Respondents were more likely to report barriers to help-seeking in the post wave, most notably worry about what the doctor may find (OR = 1.58, 1.35–1.84) and worry about wasting the doctor’s time (OR = 1.48, 1.25–1.74). Women and older individuals were the most affected. Conclusions Participants reported longer waiting times to help-seeking for cancer symptoms after the pandemic. There is an urgent need for public interventions encouraging people to consult their physicians with symptoms suggestive of cancer and counteracting the main barriers perceived during the pandemic situation.
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Affiliation(s)
- Dafina Petrova
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Marina Pollán
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,National Center for Epidemiology, Health Institute Carlos III, Madrid, Spain
| | - Miguel Rodriguez-Barranco
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain. .,Escuela Andaluza de Salud Pública (EASP), Granada, Spain. .,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
| | | | - Josep M Borrás
- Department of Clinical Sciences, University of Barcelona, Barcelona, Spain.,Bellvitge Biomedical Research Institute, Hospitalet, Spain.,NHS Cancer Strategy, Ministry of Health, Hospitalet, Spain
| | - Maria-José Sánchez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
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17
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Anaba U, Hutchinson PL, Abegunde D, White Johansson E. Pneumonia-related ideations, care-seeking, and treatment behaviors among children under 2 years with pneumonia symptoms in northwestern Nigeria. Pediatr Pulmonol 2020; 55 Suppl 1:S91-S103. [PMID: 31990144 DOI: 10.1002/ppul.24644] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/05/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prompt treatment of pediatric pneumonia symptoms is a cornerstone of child survival programs but remains a challenge in Nigeria. Psychosocial influences, or ideations, directly influence pathways to care but have not been previously measured or examined for pediatric pneumonia. METHODS A two-stage cluster-sample cross-sectional population-based survey was conducted in Kebbi, Sokoto, and Zamfara States in September 2019. Across 108 enumeration areas, all households were enumerated to census pregnant women and randomly sample women with children under 2 years ("under-twos") for inclusion. Respondents were asked about pediatric pneumonia and other health-related behaviors and ideations developed using the Ideation Model of Strategic Communication and Behavior Change. Prevalence ratios for predictors of care-seeking from formal medical sources and antibiotic treatment for pneumonia symptoms among under-twos were calculated using mixed-effects Poisson regression models with robust error variance. RESULTS Among 350 under-twos with pneumonia symptoms, 33.8% were taken to formal medical care and 38.0% used antibiotics. Women who positively viewed treatment efficacy and those who positively viewed health services quality had 1.35 (95% CI: 1.00-1.82; P = .050) and 2.13 (95% CI: 1.35-3.35; P = .001) times higher likelihood of attending formal medical sources, while women viewing peers as mostly attending drug shops had 29% lower likelihood. Perceived treatment efficacy and illness susceptibility were also significant predictors for antibiotic use. CONCLUSIONS Program interventions focusing on increasing pneumonia knowledge alone may not be sufficient to improve care-seeking and treatment rates and should expand to address perceived and actual poor-quality health services and maternal beliefs about treatment efficacy, social norms, illness severity, and susceptibility.
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Affiliation(s)
- Udochisom Anaba
- Breakthrough RESEARCH/Nigeria, Abuja, Nigeria.,Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans
| | - Paul L Hutchinson
- Breakthrough RESEARCH/Nigeria, Abuja, Nigeria.,Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans
| | - Dele Abegunde
- Breakthrough RESEARCH/Nigeria, Abuja, Nigeria.,Population Council, Washington, District of Columbia
| | - Emily White Johansson
- Breakthrough RESEARCH/Nigeria, Abuja, Nigeria.,Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans
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