The role of social context in symptom appraisal and help-seeking among people with lung or colorectal symptoms: A qualitative interview study

Lack of social support, gender and colorectal cancer screening participation across Europe: How do screening programmes mitigate the effect of social support for men and women?

This study investigates how a lack of social support differentially affects men and women's colorectal cancer (CRC) screening participation, considering different screening strategies implemented across European countries. Although health sociology has stressed gender differences in social support and its effects on health behaviours, this was overlooked by cancer screening research. Using a data set of 65,961 women and 55,602 men in 31 European countries, we analysed the effect of social support variables on CRC screening uptake. We found that living alone and lower perceived social support were associated with lower screening uptake for both men and women. These effects were, however, stronger among men. Population-based screening programmes mitigated these effects, particularly for women, but not for men living alone. In countries with opportunistic screening programmes, social support variables remained associated with screening uptake. We conclude that cancer screening interventions should pay attention to social support and its gender-differentiated effects.

Factors influencing the acceptability of alcohol drinking for a patient with colorectal cancer

INTRODUCTION

Colorectal cancer is the second deadliest cancer worldwide. One of the risk factors for the development of this type of cancer is alcohol consumption. Patients with colorectal cancer may be stigmatized regarding their cancer and regarding drinking behaviors they may exhibit. This study aimed to analyze community persons' and health professionals' acceptability judgments regarding alcohol drinkers having colorectal cancer.

METHOD

This study relies on an experimental method enabling the identification of variables involved in one's judgment, based on the exhaustive combination of factors yielding several scenarios rated by participants. Scenarios implemented factors possibly influencing participants' perception of a woman character having colorectal cancer. Factors included her drinking habits, post-diagnosis drinking behavior and type of diagnosis/prognosis. The participants were community persons (N' = 132) or health professionals (N" = 126). Data were analyzed using a within-subject factorial ANOVA.

RESULTS

In both samples, the "Post-diagnosis behavior" factor had large effect sizes, with drinking cessation being more acceptable than other drinking behaviors. Another factor, "Drinking habits", had significant influences on participants judgments, as higher drinking was considered less acceptable. A third factor, "Diagnosis" (polyps, early- or late-stage cancer), was taken into account by participants when it interacted with "Drinking habits" and "Post-diagnosis behavior". Indeed, participants considered most acceptable to continue drinking in the case of late-stage cancer, especially in the health professional sample where the acceptability of continuing drinking was almost doubled when the character had advanced- rather than early-cancer.

CONCLUSION

The lesser the drinking behavior, the better the acceptability. However, advanced cancer stage attenuated the poor acceptability of drinking in both samples, as participants' attitudes were more permissive when the patient had advanced cancer.

Symptom appraisal and help seeking in males with symptoms of possible prostate cancer: a qualitative study with an ethnically diverse sample in London

BACKGROUND

Prostate cancer mortality in Black males is disproportionately high. This problem may be overcome by reducing delays in the pathway to diagnosis, particularly those occurring before initial medical help seeking. A greater understanding of symptom appraisal and help seeking could support the development of targeted interventions for improving early presentation among Black males.

AIM

To provide an in-depth understanding of males' pre-consultation experiences following the onset of symptoms of possible prostate cancer, identifying both general trends as well as potential differences that may exist between Black and White males.

DESIGN AND SETTING

Qualitative study of 18 males (nine Black, nine White) in London, UK, who had recently seen their GP with urinary symptoms, erectile dysfunction, or haematuria.

METHOD

Semi-structured interviews from a previous multi-methods study of primary care use by males with symptoms of possible prostate cancer were analysed using thematic framework analysis.

RESULTS

Symptoms were often interpreted by patients as unimportant. Most delays occurred due to the absence of reasons to seek help, which, in Black males, often stemmed from poor awareness of prostate cancer. This lack of awareness could have been a consequence of their reluctance to seek health information and discuss health issues with others in their social network. Friends and relatives played an important role in symptom appraisal and help seeking.

CONCLUSION

Cognitive biases, cultural stigmas, and everyday interpersonal interactions should be important areas at which to target strategies seeking to reduce delays and improve early presentation in males with possible prostate cancer, particularly Black males.

Associations between smoking status and involvement of personal and professional relations among individuals reporting symptoms related to a diagnosis of lung cancer: a population-based study

BACKGROUND

Smoking is the leading cause of lung cancer, but individuals who currently smoke seek healthcare less frequently. This study of individuals reporting symptoms related to diagnosis of lung cancer has the following aims: 1) to explore the involvement of personal and professional relations; 2) to analyse whether age, sex and smoking status are associated with involving personal and professional relations; and 3) to analyse whether involving a personal relation is associated with healthcare-seeking.

METHODS

Data was extracted from a Danish population-based survey from 2012 with 100,000 randomly selected invitees 20 years or older. We describe the involvement of personal and professional relations among individuals experiencing four predefined symptoms indicative of lung cancer: prolonged coughing, prolonged hoarseness, shortness of breath and haemoptysis, either alone or in combination. Using multivariate logistic regression, we analyse the associations between involving personal or professional relations and various covariates (sex, age, smoking status). Moreover, we analyse the association between involving a personal relation and healthcare-seeking.

RESULTS

A total of 35,958 individuals over 40 years old completed the questionnaire. Of these, 5,869 individuals reported at least one lung cancer symptom. A higher percentage of participants with prolonged hoarseness and prolonged coughing reported no involvement of personal and professional relations (27.6% and 22.7%, respectively) compared to shortness of breath (12.4%). The most involved personal and professional relations were the spouse (46.2-62.5%) and the general practitioner (GP) (31.3-54.5%), respectively. Women and individuals in the oldest age group had higher odds of involving personal and professional relations. Individuals who currently smoke involved all relations less frequently than individuals who formerly,- and never smoked. Odds of contacting the GP or another doctor were three to seven-fold higher when a personal relation was also involved.

CONCLUSION

Women and the oldest age group had higher odds of involving relations, whereas individuals who currently smoked tended to be less likely to contact any personal or professional relations. Involving a personal relation was associated with higher odds of healthcare-seeking. The findings could be useful for GPs in terms of identifying patients at risk of postponing relevant healthcare-seeking with potential lung cancer symptoms.

Involvement of personal and professional relations when experiencing colorectal cancer symptoms - a cross sectional study

OBJECTIVE

As part of improving early diagnosis of colorectal cancer (CRC), knowledge about involvement of personal and professional relations, when experiencing CRC symptoms, is important. This study aimed to analyse involvement of personal and professional relations and whether age, sex, number of symptoms and available social network are associated with involving family, non-family and professional relations amongst individuals experiencing CRC symptoms.

METHODS

Some, 100 000 Danes over 20 years were randomly selected and invited to a cross sectional survey comprising questions about involvement of relations regarding four predefined CRC symptoms (abdominal pain, rectal bleeding and change in stool texture and frequency).

RESULTS

In total, 35 801 respondents over 40 years answered all relevant items and 9346 (26.1%) had experienced at least one CRC symptom in the preceding 4 weeks. Abdominal pain was more often than stool-related symptoms discussed with relations. Respondents with >1 symptom had higher odds of reporting general practitioner (GP) contact compared to respondents with single symptoms. Age ≥60 years was associated with higher odds of GP contact and involving family relations. Spouse/partner was the most frequently involved relation. Involving a personal relation increased the odds of GP contact. Having an available social network decreased GP contact for some symptoms.

CONCLUSION

Odds of involving professional relations, e.g. the GP, were higher amongst individuals experiencing multiple CRC symptoms and those involving personal relations. Having an available social network was associated with lower odds of GP contact, suggesting that individuals with no available social network are more prone to use their GP.

Defining timeliness in care for patients with lung cancer: a scoping review

OBJECTIVES

Early diagnosis and reducing the time taken to achieve each step of lung cancer care is essential. This scoping review aimed to examine time points and intervals used to measure timeliness and to critically assess how they are defined by existing studies of the care seeking pathway for lung cancer.

METHODS

This scoping review was guided by the methodological framework for scoping reviews by Arksey and O'Malley. MEDLINE, EMBASE, CINAHL and PsycINFO electronic databases were searched for articles published between 1999 and 2019. After duplicate removal, all publications went through title and abstract screening followed by full text review and inclusion of articles in the review against the selection criteria. A narrative synthesis describes the time points, intervals and measurement guidelines used by the included articles.

RESULTS

A total of 2113 articles were identified from the initial search. Finally, 68 articles were included for data charting process. Eight time points and 14 intervals were identified as the most common events researched by the articles. Eighteen different lung cancer care guidelines were used to benchmark intervals in the included articles; all were developed in Western countries. The British Thoracic Society guideline was the most frequently used guideline (20%). Western guidelines were used by the studies in Asian countries despite differences in the health system structure.

CONCLUSION

This review identified substantial variations in definitions of some of the intervals used to describe timeliness of care for lung cancer. The differences in healthcare delivery systems of Asian and Western countries, and between high-income countries and low-income-middle-income countries may suggest different sets of time points and intervals need to be developed.

Experiences along the diagnostic pathway for patients with advanced lung cancer in the USA: a qualitative study

BACKGROUND

Most patients with lung cancer are diagnosed at advanced stages. However, the advent of oral targeted therapies has improved the prognosis of many patients with lung cancer.

PURPOSE

We aimed to understand the diagnostic experiences of patients with advanced lung cancer with oncogenic mutations.

METHODS

Qualitative interviews were conducted with patients with advanced or metastatic non-small cell lung cancer with oncogenic alterations. Patients were recruited from online support groups within the USA. Interviews were conducted remotely or in person. Analysis used an iterative inductive and deductive process. Themes were mapped to the Model for Pathways to Treatment.

RESULTS

40 patients (12 male and 28 female) with a median age of 48 were included. We identified nine distinct themes. During the 'patient interval', individuals became concerned about symptoms, but often attributed them to other causes. Prolonged or more severe symptoms prompted care-seeking. During the 'primary care interval', doctors initially treated for illnesses other than cancer. Discovery of an imaging abnormality was a turning point in diagnostic pathways. Occasionally, severity of symptoms prompted patients to seek emergency care. During the 'secondary care interval', obtaining tissue samples was pivotal in confirming diagnosis. Delays in accessing oncology care sometimes led to patient distress. Obtaining genetic testing was crucial in directing patients to receive targeted treatments.

CONCLUSIONS

Patients experienced multiple different routes to their diagnosis. Some patients perceived delays, inefficiencies and lack of coordination, which could be distressing. Shifting the stage of diagnosis of lung cancer to optimise the impact of targeted therapies will require concerted efforts in early detection.

Evaluation of a web-based, tailored intervention to encourage help-seeking for lung cancer symptoms: a randomised controlled trial

Background

People with lung cancer often wait for several months before presenting symptoms to health services. Some patients report seeking information online to help them appraise symptoms. No research has evaluated whether websites about lung cancer present information in an optimal manner to encourage help-seeking.

Objective

To evaluate the effectiveness of an online, tailored, theory-based intervention in encouraging help-seeking behaviour among people with potential lung cancer symptoms.

Methods

The intervention consisted of a specialised website which provided tailored information about lung cancer and included a component to address beliefs about help-seeking, based on the Theory of Planned Behaviour (TPB-component). Individuals with undiagnosed symptoms were randomised to receive information about lung cancer in a factorial design (tailored/untailored × TPB-component/no TPB-component). Pre and post viewing webpages, participants reported perceived likelihood of seeking help. Data were analysed using robust mixed factorial ANOVA.

Results

Data from 253 participants (73.9% female) were analysed. No effect for the TPB-component was found (p = 0.16), nor for tailoring (p = 0.27). Self-reported likelihood of seeking help increased significantly from pre to post (p < 0.001), regardless of tailoring and TPB-components.

Conclusion

Self-reported likelihood of seeking help for potential lung cancer symptoms may increase after viewing information online. This does not appear to be affected by information tailoring and components to address beliefs. However, intentions remained unchanged in the majority of the sample. This suggests further efforts are needed to improve lung cancer websites if they are to be a useful resource for those seeking advice about their symptoms.

Is healthcare-seeking with gynaecological alarm symptoms influenced by personal and professional relations? A Danish population-based, cross-sectional study

OBJECTIVES

To identify the personal and professional relations of women experiencing gynaecological alarm symptoms, to analyse if involving a personal relation is related to healthcare-seeking with gynaecological alarm symptoms, and to analyse if having an available social network is associated with involvement of this relation.

DESIGN

Web-based, population-based, cross-sectional questionnaire survey.

SETTING

The general population in Denmark.

PARTICIPANTS

The study invited 100 000 individuals randomly drawn from the Danish Civil Registration System. Pregnant women and women who did not answer relevant questions about social network were excluded. A total of 5053 women who experienced at least one gynaecological alarm symptom were included in the study. PRIMARY AND SECONDARY OUTCOMES: (1) Personal and professional relations that women experiencing gynaecological alarm symptoms involve; (2) the association between involving a personal relation and healthcare-seeking; and (3) the association between having an available social network and involvement of this relation.

RESULTS

The general practitioner (GP) was the most involved professional relation, while the spouse/partner was the most involved personal relation. When experiencing gynaecological alarm symptoms, more than 50% of women did not involve a professional relation and 20% did not involve a personal relation. For all four gynaecological alarm symptoms, the odds of involving the GP were higher in the oldest age group. Women were two to seven times more likely to involve their GP if they had personal relation involvement. No statistically significant association was found between having an available social network and involving the GP.

CONCLUSION

Involving a personal relation in healthcare-seeking was associated with increased involvement of the GP, who consequently was the most involved professional relation when experiencing gynaecological alarm symptoms. Spouse/partner was the most involved personal relation. The oldest age group had the highest odds of involving the GP. No association was found between having an available social network and involving the GP.

Patient symptom experience prior to a diagnosis of oesophageal or gastric cancer: a multi-methods study

Background

Late stage diagnosis of oesophageal and gastric cancer is common, which limits treatment options and contributes to poor survival.

Aim

To explore patients' understanding, experience and presentation of symptoms before a diagnosis of oesophageal or gastric cancer.

Design & setting

Between May 2016 and October 2017, all patients newly diagnosed with oesophageal or gastric cancer were identified at weekly multidisciplinary team meetings at two large hospitals in England. A total of 321 patients were invited to participate in a survey and secondary care medical record review; 127 (40%) participants responded (102 patients had oesophageal cancer and 25 had gastric cancer). Of these, 26 participated in an additional face-to-face interview.

Method

Survey and medical record data were analysed descriptively. Interviews were analysed using thematic analysis, informed by the Model of Pathways to Treatment.

Results

Participants experienced multiple symptoms before diagnosis. The most common symptom associated with oesophageal cancer was dysphagia (n = 66, 65%); for gastric cancer, fatigue or tiredness (n = 20, 80%) was the most common symptom. Understanding of heartburn, reflux and indigestion, and associated symptoms differed between participants and often contrasted with clinical perspectives. Bodily changes attributed to personal and/or lifestyle factors were self-managed, with presentation to primary care prompted when symptoms persisted, worsened, or impacted daily life, or were notably severe or unusual. Participants rarely presented all symptoms at the initial consultation.

Conclusion

The patient interval may be lengthened by misinterpretation of key terms, such as heartburn, or misattribution or non-recognition of important bodily changes. Clearly defined symptom awareness messages may encourage earlier help-seeking, while eliciting symptom experience and meanings in primary care consultations could prompt earlier referral and diagnosis.

Reconceptualising Rural Cancer Inequalities: Time for a New Research Agenda

Evidence has shown for over 20 years that patients residing in rural areas face poorer outcomes for cancer. The inequalities in survival that rural cancer patients face are observed throughout the developed world, yet this issue remains under-examined and unexplained. There is evidence to suggest that rural patients are more likely to be diagnosed as a result of an emergency presentation and that rural patients may take longer to seek help for symptoms. However, research to date has been predominantly epidemiological, providing us with an understanding of what is occurring in these populations, yet failing to explain why. In this paper we outline the problems inherent in current research approaches to rural cancer inequalities, namely how ‘cancer symptoms’ are conceived of and examined, and the propensity towards a reductionist approach to rural environments and populations, which fails to account for their heterogeneity. We advocate for a revised rural cancer inequalities research agenda, built upon in-depth, community-based examinations of rural patients’ experiences across the cancer pathway, which takes into account both the micro and macro factors which exert influence on these experiences, in order to develop meaningful interventions to improve cancer outcomes for rural populations.

'It is just part of life': patient perspectives and experiences of diagnostic imaging referrals

Referral for a medical imaging examination is an integral part of the medical consultation; however, not much is known about patients' experience of these referrals. The life-world experiences and perspectives of patients as 'persons' referred for an imaging investigation are explored through the lens of person-centred and whole-person care. Individual interviews were conducted with 22 patients referred for an imaging investigation. The findings were interpreted in terms of the journey of a patient; that is, the processes the patient undergoes as a person in the course of a referral for a diagnostic imaging investigation as part of the disease and its treatment. Participants' life and health journeys are described in terms of three themes: (1) events leading to an imaging examination; (2) the imaging referral experience embedded within the medical encounter; and (3) the integration of the findings of the imaging examination into their everyday life. Health practitioners should be mindful of the complexity of medical consultations that include a referral for an imaging investigation.

Lay people's psychological reactions and helping intention after friends' cancer disclosure: An exploratory analysis using vignettes

OBJECTIVES

Stigma, anticipated responses from others, and their relationships may affect patients' decision-making of cancer disclosure. However, little research has explored responses to cancer disclosure and the outcome from receivers' perspectives who had stereotypic views of cancer. This vignette study aimed to explore how lay people with negative attitude to cancer would react to the friend's cancer disclosure.

METHODS

A cross-sectional survey study was conducted in community organisations. Of 161 recruited, 91 participants returned their questionnaires (56.5% of response rate). A total of 88 responses to open-ended questions were qualitatively analysed.

RESULTS

Thematic analysis extracted four themes: 'Initial emotional reactions and the acceptance of the friend's cancer diagnosis'; 'Empathy, trust and helping intention'; 'Sharing informational and emotional support provision'; and 'Offering help, but waiting and seeing the friend's request.' As a result of comparison to these themes by the participants' familiarity of cancer patients in their real life, it was found that participants, who had not known any cancer patients, did not report the acceptance of the friends' cancer diagnosis and informational support provision to share.

CONCLUSION

Intervention for lay people who felt difficulty with accepting friends' cancer diagnosis may be helpful to reduce the impact of friends' cancer diagnosis.

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

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.