Katie Mills
Understanding symptom appraisal and help-seeking in people with symptoms suggestive of pancreatic cancer: a qualitative study
Mills, Katie; Birt, Linda; Emery, Jon D; Hall, Nicola; Banks, Jonathan; Johnson, Margaret; Lancaster, John; Hamilton, William; Rubin, Greg P; Walter, Fiona M
Authors
Linda Birt
Jon D Emery
Nicola Hall
Jonathan Banks
Margaret Johnson
John Lancaster
William Hamilton
Greg P Rubin
Fiona M Walter
Abstract
Objective: Pancreatic cancer has poor survival rates due to non-specific symptoms leading to later diagnosis. Understanding how patients interpret their symptoms could inform approaches to earlier diagnosis. This study sought to explore symptom appraisal and help-seeking among patients referred to secondary care for symptoms suggestive of pancreatic cancer. Design: Qualitative analysis of semistructured in-depth interviews. Data were analysed iteratively and thematically, informed by the Model of Pathways to Treatment. Participants and setting: Pancreatic cancer occurs rarely in younger adults, therefore patients aged ≥40 years were recruited from nine hospitals after being referred to hospital with symptoms suggestive of pancreatic cancer; all were participants in a cohort study. Interviews were conducted soon after referral, and where possible, before diagnosis. Results: Twenty-six interviews were conducted (cancer n=13 (pancreas n=9, other intra-abdominal n=4), non-cancer conditions n=13; age range 48–84 years; 14 women). Time from first symptoms to first presentation to healthcare ranged from 1 day to 270 days, median 21 days. We identified three main themes. Initial symptom appraisal usually began with intermittent, non-specific symptoms such as tiredness or appetite changes, attributed to diet and lifestyle, existing gastrointestinal conditions or side effects of medication. Responses to initial symptom appraisal included changes in meal type or frequency, or self-medication. Symptom changes such as alterations in appetite and enjoyment of food or weight loss usually prompted further appraisal. Triggers to seek help included a change or worsening of symptoms, particularly pain, which was often a ‘tipping point’. Help-seeking was often encouraged by others. We found no differences in symptom appraisal and help-seeking between people diagnosed with cancer and those with other conditions. Conclusions: Greater public and healthcare professional awareness of the combinations of subtle and intermittent symptoms, and their evolving nature, is needed to prompt timelier help-seeking and investigation among people with symptoms of pancreatic cancer.
Citation
Mills, K., Birt, L., Emery, J. D., Hall, N., Banks, J., Johnson, M., …Walter, F. M. (2017). Understanding symptom appraisal and help-seeking in people with symptoms suggestive of pancreatic cancer: a qualitative study. BMJ Open, 7(9), Article e015682. https://doi.org/10.1136/bmjopen-2016-015682
Journal Article Type | Article |
---|---|
Acceptance Date | Aug 31, 2017 |
Online Publication Date | Sep 3, 2017 |
Publication Date | Sep 3, 2017 |
Deposit Date | Oct 10, 2017 |
Publicly Available Date | Oct 10, 2017 |
Journal | BMJ Open |
Publisher | BMJ Publishing Group |
Peer Reviewed | Peer Reviewed |
Volume | 7 |
Issue | 9 |
Article Number | e015682 |
DOI | https://doi.org/10.1136/bmjopen-2016-015682 |
Public URL | https://durham-repository.worktribe.com/output/1347226 |
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Copyright Statement
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
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