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Symptom appraisal and healthcare-seeking for symptoms suggestive of colorectal cancer: a qualitative study

Hall, Nicola, Birt, L, Banks, J, Emery, J, Mills, K, Johnson, M, Rubin, G P, Hamilton, W and Walter, F M (2015) Symptom appraisal and healthcare-seeking for symptoms suggestive of colorectal cancer: a qualitative study. BMJ Open, 5 (10). e008448. ISSN 2044-6055

Item Type: Article

Abstract

Objectives Timely diagnosis of colorectal cancer is important to improve survival. This study explored symptom appraisal and help-seeking among patients referred to specialist services with symptoms of colorectal cancer.

Design Qualitative in-depth interview study.

Setting and participants Participants were recruited on referral to gastroenterology clinics (North East and East of England); interviews were conducted soon after referral. We purposively sampled participants to ensure a range of accounts in terms of age, sex, diagnosis and geographical location.

Methods Data collection and analysis were underpinned by the Model of Pathways to Treatment. Framework analysis was used to explore the data within and across cases, focusing on patient beliefs and experiences, disease factors and healthcare influences.

Results 40 participants were interviewed (aged 43–87 years, 17 women, 18 diagnosed with colorectal cancer). Patients diagnosed with and without colorectal cancer had similar symptom pathways. We found a range of interacting and often competing biopsychosocial, contextual and cultural influences on the way in which people recognised, interpreted and acted on their symptoms. People attempted to ‘maintain normality’ through finding benign explanations for their symptoms. Bodily changes were appraised within the context of usual bowel patterns, comorbidities and life events, and decisions to seek help were made in relation to expectations about the course of symptoms. The ‘private nature’ of colorectal cancer symptoms could affect both their identification and discussions with others including healthcare professionals. Within the context of the National Health Service, people needed to legitimise appropriate use of healthcare services and avoid being thought of as wasting doctors’ time.

Conclusions Findings provide guidance for awareness campaigns on reducing stigma around appraising and discussing bowel movements, and the importance of intermittent and non-specific symptoms. Altering perceptions about the appropriate use of health services could have a beneficial effect on time to presentation.

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More Information

Depositing User: Nicola Hall

Identifiers

Item ID: 6680
Identification Number: https://doi.org/10.1136/bmjopen-2015-008448
ISSN: 2044-6055
URI: http://sure.sunderland.ac.uk/id/eprint/6680
Official URL: http://dx.doi.org/10.1136/bmjopen-2015-008448

Users with ORCIDS

Catalogue record

Date Deposited: 07 Oct 2016 14:15
Last Modified: 06 Feb 2020 09:55

Contributors

Author: Nicola Hall
Author: L Birt
Author: J Banks
Author: J Emery
Author: K Mills
Author: M Johnson
Author: G P Rubin
Author: W Hamilton
Author: F M Walter

University Divisions

Faculty of Health Sciences and Wellbeing

Subjects

Social Sciences > Health and Social Care
Sciences > Health Sciences
Psychology > Psychology
Social Sciences

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