Abstract
BackgroundDelay in help seeking for cancer ‘alarm’ symptoms has been identified as a contributor to delayed diagnosis.AimTo understand people’s help-seeking decision making for cancer alarm symptoms, without imposing a cancer context.Design and settingCommunity-based, qualitative interview study in the UK, using purposive sampling by sex, socioeconomic status, and prior help seeking, with framework analysis of transcripts.MethodInterviewees (n = 48) were recruited from a community-based sample (n = 1724) of adults aged ≥50 years who completed a health survey that included a list of symptoms. Cancer was not mentioned. Participants reporting any of 10 cancer alarm symptoms (n = 915) and who had consented to contact (n = 482) formed the potential pool from which people were invited to an interview focusing on their symptom experiences.ResultsReasons for help seeking included symptom persistence, social influence, awareness/fear of a link with cancer, and ‘just instinct’. Perceiving the symptom as trivial or ‘normal’ was a deterrent, as was stoicism, adopting self-management strategies, and fear of investigations. Negative attitudes to help seeking were common. Participants did not want to be seen as making a fuss, did not want to waste the doctor’s time, and were sometimes not confident that the GP could help.ConclusionDecision making about cancer alarm symptoms was complex. Recognition of cancer risk almost always motivated help seeking (more so than the fear of cancer being a deterrent), assisted by recent public-awareness campaigns. As well as symptom persistence motivating help seeking, it could also have the reverse effect. Negative attitudes to help seeking were significant deterrents.
Highlights
Decision making about cancer alarm symptoms was complex
The UK has worse cancer survival rates than other countries with similar healthcare systems;[1,2] this is partly attributed to delayed diagnosis.[3]
N = 809 (46.9%) did not report at least one cancer alarm symptom n = 915 (53.1%) reported at least one cancer alarm symptom n = 433 (47.3%) did not agree to be contacted again n = 482 (52.7%) agreed to be contacted again n = 131 (27.2%) people invited for interview
Summary
The UK has worse cancer survival rates than other countries with similar healthcare systems;[1,2] this is partly attributed to delayed diagnosis.[3] One difference between the UK and some other European healthcare systems is that in the UK there is a gatekeeping system, in which primary care is the first point of contact — and the only route — into specialist care.[4]. Data from 19 European countries suggest that those with gatekeeping systems have poorer 1-year survival rates; a proxy for later diagnosis.[4] some of this may be related to the diagnostic interval (time from first consulting to diagnosis),[5] patients’ willingness to seek help may contribute.[4] Qualitative evidence from Denmark, which has a gatekeeping system, has highlighted issues such as previous patient experience of non-referral and the perceived need to ‘legitimise’ consultations as leading to restricted care seeking.[6] Worry about wasting the doctors’ time was more commonly endorsed as a barrier in the UK than in Australia, Canada, or Scandinavia.[7]. Delay in help seeking for cancer ‘alarm’ symptoms has been identified as a contributor to delayed diagnosis
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