Over-reassurance and undersupport after a ‘false alarm’: a systematic review of the impact on subsequent cancer symptom attribution and help seeking

Abstract

ObjectivesThis literature review examined research into the impact of a previous ‘all-clear’ or non-cancer diagnosis following symptomatic presentation (‘false alarm’) on symptom attribution and delays in help seeking for subsequent possible cancer symptoms.Design and settingThe comprehensive literature review included original research based on quantitative, qualitative and mixed data collection methods. We used a combination of search strategies, including in-depth searches of electronic databases (PubMed, EMBASE, PsychInfo), searching key authors and articles listed as ‘related’ in PubMed, and reference lists. We performed a narrative synthesis of key themes shared across studies.ParticipantsThe review included studies published after 1990 and before February 2014 reporting information on adult patients having experienced a false alarm following symptomatic presentation. We excluded false alarms in the context of screening.Primary and secondary outcome measuresWe evaluated the effect of a ‘false alarm’ on symptom attribution and help seeking for new or recurrent possible cancer symptoms.ResultsOverall, 1442 papers were screened and 121 retrieved for full-text evaluation. Among them, 19 reported on false alarms and subsequent symptom attribution or help seeking. They used qualitative (n=14), quantitative (n=3) and mixed methods (n=2). Breast (n=7), gynaecological (n=3), colorectal (n=2), testicular (n=2), and head and neck cancers (n=2) were the most studied. Two broad themes emerged underlying delays in help seeking: (1) over-reassurance from the previous ‘all-clear’ diagnosis leading to subsequent symptoms being interpreted as benign, and (2) unsupportive healthcare experiences in which symptoms were dismissed, leaving patients concerned about appearing hypochondriacal or uncertain about the appropriate next actions. The evidence suggested that the effect of a false alarm can persist for months and even years.ConclusionsIn conclusion, over-reassurance and undersupport of patients after a false alarm can undermine help seeking in the case of new or recurrent potential cancer symptoms, highlighting the need for appropriate patient information when investigations rule out cancer.

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

“…The authors found evidence of patients delaying before presenting symptoms after a previous 'allclear' message, which confirms similar results reported after symptomatic presentation. 16,17 Furthermore, the finding that some patients may wait for their next round of screening instead of seeking more immediate help from their GP regarding symptoms resonates with similar results presented by Solbjør and colleagues. 18 Patient knowledge of cancer symptoms was shown in this study to be an important mediating factor in initiating help-seeking behaviour.…”

Health and health belief factors associated with screening and help‐seeking behaviours for breast cancer: A systematic review and meta‐analysis of the European evidence

“…Perceived susceptibility can then act both as a facilitator and as a barrier to future screening depending on how much distress has been caused by the false positive (Bond et al, 2013), and how much benefit is seen in subsequent screening (Fair et al, 2012). However, this review also revealed that a previous false alarm for a symptomatic presentation was associated with a longer time to presentation, and it may be that a previous normal or benign result lowers perception of risk so that new symptoms are interpreted as non-cancerous (Renzi, Whitaker, & Wardle, 2015). Additionally, women who detect a new symptom may prefer to wait for their next scheduled mammogram rather than seeing a doctor earlier (Solbjør, Skolbekken, Saetnan, Hagen, & Forsmo, 2012), or have been over-reassured by a previous benign result and so do not interpret the symptom as being of significance, leading to a longer time to presentation (Renzi et al, 2015;Smith, Pope, & Botha, 2005).…”

The expanding role of primary care in cancer control

“…Previous reassurance from the PCP about the same type of symptom can also reduce the likelihood that the patient will interpret the symptom as serious. 66 The emotional domain (ie, fear of a cancer diagnosis) is less often cited than the cognitive domain as a reason to avoid help-seeking, but where it is, it can cause lengthy delays. In community surveys, around 10% of people said they would not want to know if they had cancer, and almost half thought that cancer treatment was worse than cancer.…”