Abstract
BackgroundLate diagnosis is considered to be a major factor contributing to poorer cancer survival rates in the UK. Interventions have focussed on the promotion of earlier diagnosis in patients with potential cancer symptoms. However, to assess the effectiveness of these interventions, the time from symptom onset to presentation needs to be reliably and accurately measured. This qualitative study explored the use of calendar landmarking instruments in cancer symptom research.MethodsWe performed a secondary analysis of transcripts of interviews using the calendar landmarking instrument, undertaken with patients who had either been diagnosed with cancer (n = 40, IRCO study, Western Australia), or who had symptoms suggestive of cancer (n = 38, SYMPTOM study, North East and Eastern England). We used constant comparison methods to identify use of the calendar landmarking instruments and the impact of their application.ResultsThe calendar landmarking instrument appeared to help many patients, either by acting as a prompt or helping to refine recall of events. A combination of personal (e.g. birthday) and national (e.g. Christmas) landmarks seemed to be the most effective. Calendar landmarking instruments appeared more useful where the time period between onset of symptoms and date of first consultation was less than three months. The interviewee’s age, gender and cancer type did not appear to influence whether or not the instrument facilitated recall, and there were no instances where the use of the instrument resulted in the disclosure of a new first symptom. Symptoms of similar chronic conditions could create difficulties when applying the instrument; it was difficult for these participants to characterise and disentangle their symptoms which prompted their decisions to seek help. Some participants tended to prefer to use their own, already personalised, diaries to assist in their recall of events.ConclusionsThis study is the first to describe the potential role of calendar landmarking instruments to support research interviews which explore symptoms and events along the cancer diagnostic pathway. The major challenge remains as to whether they actually improve accuracy of recall.
Highlights
IntroductionTo assess the effectiveness of these interventions, the time from symptom onset to presentation needs to be reliably and accurately measured
Late diagnosis is considered to be a major factor contributing to poorer cancer survival rates in the UK
Usefulness of calendar landmarking instruments In more than half of the interviews the calendar landmarking instrument appeared to help participants recall the date of their first symptom onset and/or the date of the first general practitioner (GP) consultation
Summary
To assess the effectiveness of these interventions, the time from symptom onset to presentation needs to be reliably and accurately measured. This qualitative study explored the use of calendar landmarking instruments in cancer symptom research. In order to assess the effectiveness of these interventions the time from symptom onset to diagnosis and onset of treatment needs to be reliably and accurately measured [2]. The Aarhus Statement emphasises the importance of accurate definitions and measurement of these time intervals by clinicians and researchers [5] This type of research often involves retrospective recall of symptom onset by patients; such recall is subject to many types of error which may affect the accuracy, reliability and completeness of data collection
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