Symptom appraisal and healthcare-seeking for symptoms suggestive of colorectal cancer: a qualitative study
Department of Public Health and Primary Care, University of Cambridge
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Hall, N., Birt, L., Banks, J., Emery, J., Mills, K., Johnson, M., Rubin, G., et al. (2015). Symptom appraisal and healthcare-seeking for symptoms suggestive of colorectal cancer: a qualitative study. BMJ Open, 5 (e008448)https://doi.org/10.1136/bmjopen-2015-008448
Objectives: Timely diagnosis of colorectal cancer is important to improve survival. This study explored symptom appraisal and help-seeking among patients referred to specialist services with symptoms of colorectal cancer. Design: Qualitative in-depth interview study. Setting and participants: Participants were recruited upon referral to gastroenterology clinics (North East and East of England); interviews were conducted soon after referral. We purposively sampled participants to ensure a range of accounts in terms of age, sex, diagnosis and geographical location. Methods: Data collection and analysis were underpinned by the Model of Pathways to Treatment. Framework analysis was used to explore the data within and across cases, focussing on patient beliefs and experiences, disease factors and healthcare influences. Results: 40 participants were interviewed (aged 43-87 years, 17 women, 18 diagnosed with colorectal cancer). Patients diagnosed with and without colorectal cancer had similar symptom pathways. We found a range of interacting and often competing biopsychosocial, contextual and cultural influences on the way in which people recognised, interpreted and acted upon their symptoms. People attempted to ‘maintain normality’ through finding benign explanations for their symptoms. Bodily changes were appraised within the context of usual bowel patterns, co-morbidities and life events, and decisions to seek help were made in relation to expectations about the course of symptoms. The ‘private nature’ of colorectal cancer symptoms could affect both their identification and discussions with others including healthcare professionals. Within the context of the NHS, people needed to legitimise appropriate use of healthcare services and avoid being thought to waste doctors’ time. Conclusions: Findings provide guidance for awareness campaigns on reducing stigma around appraising and discussing bowel movements, and the importance of intermittent and non-specific symptoms. Altering perceptions about the appropriate use of health services could have a beneficial effect on time to presentation.
cancer, colorectal, diagnosis, oncology, behaviour, help-seeking
This paper presents independent research funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme, RP-PG-0608-10045.
National Institute for Health Research (NIHR) (via University of Bristol) (RP PG 0608 10045)
External DOI: https://doi.org/10.1136/bmjopen-2015-008448
This record's URL: https://www.repository.cam.ac.uk/handle/1810/249171
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Licence URL: http://creativecommons.org/licenses/by/4.0/