Socioeconomic differences in help seeking for colorectal cancer symptoms during COVID-19: a UK-wide qualitative interview study

Abstract

Background: COVID-19 has led to rapid changes in health care delivery, raising concern that these changes may exacerbate existing inequalities in patient outcomes. Aim: To understand how patients’ help-seeking experiences in primary care for colorectal cancer symptoms during COVID-19 were affected by socioeconomic status (SES). Design & setting: Qualitative semi-structured interviews with men and women across the UK, recruited using purposive sampling by SES. Method: Interviews were carried out with 39 participants (20 higher SES; 19 lower SES) who contacted primary care about possible symptoms of colorectal cancer during COVID-19. Data were analysed using framework analysis followed by comparative thematic analysis to explore differences between groups. Results: Three themes were identified with differences between SES groups: (1) How people decided to seek medical help through appraisal of symptoms; (2) How people navigated services; and (3) Impact of COVID-19 on how patients interacted with healthcare professionals. The lower SES group expressed uncertainty appraising symptoms and navigating services (in terms of new processes resulting from covid and worries about infection). There was also potential for increased disparity in diagnosis and management, with other methods of getting in touch (e.g., email, 111) taken up more readily by higher SES patients. Conclusion: Our findings suggest that COVID-19 exacerbated disparities between higher and lower SES participants. This study raises awareness around challenges in help-seeking in the context of the pandemic which are likely to persist (post-COVID) as healthcare systems settle on new models (e.g., digital) of care. Recommendations are provided to reduce inequalities of care.

Socioeconomic differences in help seeking for colorectal cancer symptoms during COVID-19

“…We read with interest the paper by Ip et al exploring socioeconomic differences in help seeking for colorectal cancer symptoms during COVID-19. 1 While we agree with the importance of this topic, the study has significant weaknesses that limit its validity.…”

“…We welcome the opportunity to respond to Atherton et al and to provide reassurance of the methodological validity of our study. 1 We include details of other socioeconomic status (SES) indices (included in the Index of Multiple Deprivation [IMD]) in the supplementary file. Furthermore, the paper cited in the eLetter also states that education is a frequently used indicator of socioeconomic status because it is relevant to people regardless of age.…”

Healthcare Professional and Patient Perceptions of Changes in Colorectal Cancer Care Delivery During the COVID-19 Pandemic and Impact on Health Inequalities

“…We present findings from all 39 participants (focused on primary care experiences) in another paper. 18 Out of the 15 patients, 6 were from lower socioeconomic backgrounds and 9 were from higher socioeconomic backgrounds. The average age of this sub-sample was 57 years and 60% were female.…”

“…Follow-up interviews via phone or Zoom were also carried out with some patients who reported ongoing interactions and had not already spoken about their experience of further investigations in their initial interview (mean duration = 16 minutes; range: 8-23 minutes). In a previous paper 18 we focused on patient accounts of accessing primary care. In this paper, we focus on patients who were referred to secondary care for investigations.…”

Patient experience and satisfaction with symptomatic faecal immunochemical testing: an explanatory sequential mixed-methods evaluation

“…Finally, while St Helens and Knowsley represent two of the most deprived boroughs in England, the higher reported educational attainment and IMD scores suggest that the least deprived were overrepresented within the study sample. This may reflect self-sampling bias, or it may reflect recent findings which suggest that individuals from more socioeconomically deprived backgrounds were less likely to seek help for possible colorectal cancer symptoms (and therefore to complete our survey) during the COVID-19 pandemic (29).…”