‘This isn’t what mine looked like’: a qualitative study of symptom appraisal and help seeking in people recently diagnosed with melanoma
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Walter, F., Birt, L., Cavers, D., Scott, S., Emery, J., Burrows, N., Cavanagh, G., et al. (2014). ‘This isn’t what mine looked like’: a qualitative study of symptom appraisal and help seeking in people recently diagnosed with melanoma. BMJ Open https://doi.org/10.1136/bmjopen-2014-005566
Objective - To explore symptom appraisal and help-seeking decisions among patients recently diagnosed with melanomas, and to compare experiences of people with ‘thinner’ (<1mm) and ‘thicker’ (>2mm) melanomas, as thickness at diagnosis is an important prognostic feature. Methods - In-depth interviews with patients within ten weeks of melanoma diagnosis explored the factors impacting on their pathways to diagnosis. Framework analysis, underpinned by the Model of Pathways to Treatment, was used to explore the data with particular focus on patients’ beliefs and experiences, disease factors, and healthcare professional (HCP) influences. Results - 63 patients were interviewed (29-93 years, 31 women, 30 thicker melanomas). All described their skin changes using rich lay vocabulary. Many included unassuming features such as ‘just a little spot’ as well as common features of changes in size, colour and shape. There appeared to be subtly different patterns of symptoms: descriptions of vertical growth, bleeding, oozing and itch were features of thicker melanomas irrespective of pathological type. Appraisal was influenced by explanations such as normal life changes, prior beliefs, and whether skin changes matched known melanoma descriptions. Most decisions to seek help were triggered by common factors such as advice from family and friends. Eleven patients reported previous reassurance about their skin changes by a HCP, with little guidance on monitoring change or when it would be appropriate to re-consult. Conclusions - Patients diagnosed with both thinner and thicker melanomas often did not initially recognise or interpret their skin changes as warning signs or prompts to seek timely medical attention. The findings provide guidance for melanoma awareness campaigns on more appropriate images, helpful descriptive language, and the need to stress the often apparently innocuous nature of potentially serious skin changes. The importance of appropriate advice, monitoring and safety-netting procedures by HCPs for people presenting with skin changes is also highlighted.
Thanks to our funding organisation the National Awareness and Early Diagnosis Initiative (NAEDI), and to their funding partners: Cancer Research UK; Department of Health, England; Economic and Social Research Council; Health and Social Care Research and Development Division; Public Health Agency, Northern Ireland, National Institute for Social Care and Health Research, Wales and the Scottish Government. All researchers were independent of the funding body and the study sponsors and funder had no role in study design; data collection, analysis and interpretation of data; in the writing of the report; or decision to submit the article for publication. FW was supported by an NIHR Clinical Lectureship followed by a NIHR Clinician Scientist award at the time of this study. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.
National Institute for Health Research (NIHR-CS-012-030)
Cancer Research UK (A12226)
External DOI: https://doi.org/10.1136/bmjopen-2014-005566
This record's URL: https://www.repository.cam.ac.uk/handle/1810/245450
DSpace@Cambridge license, Attribution 2.0 UK: England & Wales, Creative Commons Attribution License 2.0 UK
Licence URL: http://creativecommons.org/licenses/by/2.0/uk/