Factors influencing symptom appraisal and help-seeking of older adults with possible cancer: a mixed-methods systematic review

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.

Younger age at onset of colorectal cancer is associated with increased patient's delay

AIM

This study aimed to investigate if younger age at diagnosis of colorectal cancer was associated with a diagnostic delay. The secondary objective was to evaluate if symptomatology varied with age.

METHOD

The study population consisted of the cohorts from two prospective multicentre studies conducted in Sweden and Denmark, the QoLiRECT and QoLiCOL studies. These studies investigated the quality of life in patients with colorectal cancer. Participants responded to the validated questionnaires used to extract information on patient's and doctor's delay as well as first presenting symptoms. Clinical variables were retrieved from the Swedish Colorectal Cancer Registry and the Danish Colorectal Cancer Group Database.

RESULTS

2574 patients were included, 1085 from QoLiRECT and 1489 from QoLiCOL. The probability of an increased patient's delay was higher when age decreased by 10 years (the SD in both QoLiRECT and QoLiCOL), adjusted OR 1.19 (95%CI: 1.10; 1.30), p < 0.001. A similar effect was found for doctor's delay, but the age effect was smaller in this case, adjusted OR 1.05 (95%CI: 0.97; 1.15), p = 0.177. When the age effect was analysed non-linearly, an increased probability of a delay was seen for patients from around 60 years and below. Younger patients were equally or more likely to report the symptoms of blood in stool, diarrhoea, constipation, mucus in faeces, faecal urgency, faecal emptying difficulties and pain compared to older patients.

CONCLUSION

Younger patients were more likely to have an increased patient's delay, probably contributing to a delayed diagnosis of colorectal cancer. Symptomatology at diagnosis was similar irrespective of age.

A Test-Retest Reliability Generalization Meta-Analysis of Judgments Via the Policy-Capturing Technique

Policy capturing is a widely used technique, but the temporal stability of policy-capturing judgments has long been a cause for concern. This article emphasizes the importance of reporting reliability, and in particular test-retest reliability, estimates in policy-capturing studies. We found that only 164 of 955 policy-capturing studies (i.e., 17.17%) reported a test-retest reliability estimate. We then conducted a reliability generalization meta-analysis on policy-capturing studies that did report test-retest reliability estimates—and we obtained an average reliability estimate of .78. We additionally examined 16 potential methodological and substantive antecedents to test-retest reliability (equivalent to moderators in validity generalization studies). We found that test-retest reliability was robust to variation in 14 of the 16 factors examined but that reliability was higher in paper-and-pencil studies than in web-based studies and was higher for behavioral intention judgments than for other (e.g., attitudinal and perceptual) judgments. We provide an agenda for future research. Finally, we provide several best-practice recommendations for researchers (and journal reviewers) with regard to (a) reporting test-retest reliability, (b) designing policy-capturing studies for appropriate reportage, and (c) properly interpreting test-retest reliability in policy-capturing studies.

Knowledge, attitude and practice towards early screening of colorectal cancer in Riyadh

Background and Aims:

Colorectal cancer (CRC) is a common cause of mortality worldwide. It is preventable, treatable when detected early. The aim of this study is to assess knowledge, attitude and practice (KAP) of the participants toward CRC and its early screening, and identify the sources of information on the subjects.

Methods:

We conducted a cross-sectional study on the people 40y old and above at the primary care clinics at King Saud university medical city (KSUMC) in Riyadh. The estimated sample size was 245 subjects whom we requested to complete a self-administered Arabic questionnaire, which consisted of three parts. These were: 1. Demographic data, 2. KAP toward CRC, its early detection. 3 sources of information of the public about colorectal cancer.

Results:

A total of 231 subjects participated; (54.5%) were male (mean age = 50.7 ± 9.8). About 47% of the participants heard about cancer screening, and 45% knew that colonoscopy is used for such purposes. Another 24.2% were aware that occult blood in the stool test is a method of early detection of colon cancer. About 40% to 50% of the subjects were knowledgeable about hazardous factors and cautioning symptoms for CRC. Only 6.5% of the subjects did an early screening for CRC, but 82.9% would do it if their doctor advised them to do so.

Conclusion:

The participant's knowledge and early checkups of CRC are inadequate. They would undergo early screening if their doctors advised them to do so. It is time to develop a national policy for CRC screening involving primary care doctors and utilizing social media to improve people's information.