Symptom perceptions and help-seeking behaviour prior to lung and colorectal cancer diagnoses: a qualitative study

Abstract

Background.Lung and colorectal cancer are common and have high UK mortality rates. Early diagnosis is important in reducing cancer mortality, but the literature on lung and colorectal cancers suggests many people wait for a considerable time before presenting symptoms.Objective.To gain in-depth understanding of patients’ interpretations of symptoms of lung and colorectal cancer prior to diagnosis, and to explore processes leading to help-seeking.Methods.Semi-structured interviews were conducted with patients diagnosed with lung (N = 9) or colorectal (N = 20) cancer within the previous 12 months. Patients were asked about symptoms experienced in the period preceding diagnosis, their interpretations of symptoms, and decision making for help-seeking. Thematic analysis was conducted and comparisons drawn within and across the patient groups.Results.Patients were proactive and rational in addressing symptoms; many developed alternative, non-cancer explanations based on their knowledge and experience. Discussions with important others frequently provided the impetus to consult, but paradoxically others often initially reinforced alternative explanations. Fear and denial did not emerge as barriers to help-seeking, but help-seeking was triggered when patients’ alternative explanations could no longer be maintained, for instance due to persistence or progression of symptoms.Conclusion.Patients’ reasoning, decision making and interpersonal interactions prior to diagnosis were complex. Prompting patients for additional detail on symptoms within consultations could elicit critical contextual information to aid referral decisions. Findings also have implications for the design of public health campaigns.

Patient perspectives on delays in diagnosis and treatment of cancer: a qualitative analysis of free-text data

“…22 Importantly, this study highlights how certain factors can act as either barriers or facilitators to diagnosis in different contexts. A similar observation was reported by McLachlan and colleagues 23 in their study of help-seeking behaviour prior to lung and colorectal cancer diagnosis. They observed how health professionals may act as both a barrier and a facilitator to diagnosis.…”

“…To assist with this, physicians need to explore patients' understanding of their symptoms. This finding is echoed by McLachlan and colleagues, 23 who found that prompting patients for further information within a consultation may give important details about the context of their symptoms, later aiding physician decision making. The authors further suggest that a more inclusive approach should be taken by physicians to encompass vague symptoms (for example, not just those presented in media campaigns, such as coughs and rectal bleeding) when considering the investigation of patients for potential malignancy.…”

Developing and testing a web‐based intervention to encourage early help‐seeking in people with symptoms associated with lung cancer

“…Although they tend to result in increased knowledge levels, the symptom appraisal/help‐seeking interval often remains the same (Tustin, ). People with relevant symptoms who are aware of the campaigns sometimes describe not perceiving the information as relevant to themselves (Caswell et al ., ; McLachlan et al ., ). Furthermore, due to the campaigns’ strong focus on the cough symptom, people often remain unaware of other warning signs such as backache, weight loss, or fatigue (Birt et al ., ; Caswell et al ., ; McLachlan et al ., ).…”

“…Research has indicated that patients in the United Kingdom experience symptoms for several months before presenting to health services (Corner, Hopkinson, Fitzsimmons, Barclay, & Muers, ; Corner, Hopkinson, & Roffe, ; Tod, Craven, & Allmark, ). Reasons for delayed presentation include lack of awareness of symptoms, attribution of symptoms to minor health conditions (e.g., a common cold, a smoker's cough) or ageing, and sometimes fear of finding a serious cause and fatalistic beliefs about lung cancer (Brindle, Pope, Corner, Leydon, & Banerjee, ; Corner et al ., , ; Lyratzopoulos, Liu, Abel, Wardle, & Keating, ; McCutchan, Wood, Edwards, Richards, & Brain, ; McLachlan et al ., ; Shim, Brindle, Simon, & George, ; Smith, Pope, & Botha, ; Tod & Joanne, ; Walton et al ., ).…”

The Role of Web-Based Health Information in Help-Seeking Behavior Prior to a Diagnosis of Lung Cancer: A Mixed-Methods Study

“…Research suggests lack of knowledge about lung cancer symptoms is one of the biggest barriers to help-seeking [7,9-14]. Furthermore, symptoms are often masked by preexisting comorbidities that have similar symptoms, making it difficult for the patient to distinguish between existing and new symptoms [12,15].…”