Symptom appraisal and healthcare-seeking for symptoms suggestive of colorectal cancer: a qualitative study
Symptom appraisal and healthcare-seeking for symptoms suggestive of colorectal cancer: a qualitative study
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DOI：
10.1136/bmjopen-2015-008448
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发表时间：
2015-01-01
期刊：
影响因子：
2.9
通讯作者：
Walter, F. M.
中科院分区：
文献类型：
--
作者：
Hall, N.;Birt, L.;Walter, F. M.
目的结直肠癌的及时诊断对提高生存率具有重要意义。本研究探讨转诊至专科服务的结直肠癌患者的症状评估与求助。设计定性深度访谈研究。设置及参与者被招募到转诊至消化内科诊所(英格兰东北部及东部)；访谈在转诊后不久进行。我们有目的地对参与者进行抽样，以确保年龄、性别、诊断和地理位置的范围。方法数据收集和分析以治疗路径模型为基础。结果40名受访对象(年龄43~87岁，女性17人，确诊为结直肠癌18人)接受了问卷调查。确诊为结直肠癌和非结直肠癌的患者都有类似的症状途径。我们发现，在人们识别、解释和应对症状的方式上，存在一系列相互作用、往往是相互竞争的生物、心理、社会、语境和文化影响。人们试图通过为他们的症状找到良性解释来维持正常。在通常的大便模式、合并症和生活事件的背景下评估身体变化，并根据对症状过程的预期做出寻求帮助的决定。结直肠癌症状的私密性可能会影响他们的识别以及与包括医疗保健专业人员在内的其他人的讨论。在国民健康服务的背景下，人们需要将适当使用医疗服务合法化，避免被认为是在浪费医生的时间。结论研究结果为减少评估和讨论肠道运动的耻辱以及间歇性和非特异性症状的重要性的宣传活动提供了指导。改变对适当使用卫生服务的看法可能会对陈述的时间产生有益的影响。
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 43-87years, 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.