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Patients' initial s...
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MacArtney, JohnUniversity of Oxford
(author)
Patients' initial steps to cancer diagnosis in Denmark, England and Sweden : what can a qualitative, cross-country comparison of narrative interviews tell us about potentially modifiable factors?
- Article/chapterEnglish2017
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LIBRIS-ID:oai:lup.lub.lu.se:348c39c2-0930-45c0-8a1b-81d77801358b
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https://lup.lub.lu.se/record/348c39c2-0930-45c0-8a1b-81d77801358bURI
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https://doi.org/10.1136/bmjopen-2017-018210DOI
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http://kipublications.ki.se/Default.aspx?queryparsed=id:137567967URI
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https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-142105URI
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Language:English
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Summary in:English
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Subject category:art swepub-publicationtype
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Subject category:ref swepub-contenttype
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OBJECTIVES: To illuminate patterns observed in International Cancer Benchmarking Programme studies by extending understanding of the various influences on presentation and referral with cancer symptoms.DESIGN: Cross-country comparison of Denmark, England and Sweden with qualitative analysis of in-depth interview accounts of the prediagnostic process in lung or bowel cancer.PARTICIPANTS: 155 women and men, aged between 35 and 86 years old, diagnosed with lung or bowel cancer in 6 months before interview.SETTING: Participants recruited through primary and secondary care, social media and word of mouth. Interviews collected by social scientists or nurse researchers during 2015, mainly in participants' homes.RESULTS: Participants reported difficulties in interpreting diffuse bodily sensations and symptoms and deciding when to consult. There were examples of swift referrals by primary care professionals in all three countries. In all countries, participants described difficulty deciding if and when to consult, highlighting concerns about access to general practitioner appointments and overstretched primary care services, although this appears less prominent in the Swedish data. It was not unusual for there to be more than one consultation before referral and we noted two distinct patterns of repeated consultation: (1) situations where the participant left the primary care consultation with a plan of action about what should happen next; (2) participants were unclear about under which conditions to return to the doctors. This second pattern sometimes extended over many weeks during which patients described uncertainty, and sometimes frustration, about if and when they should return and whether there were any other feasible investigations. The latter pattern appeared more evident in the interviews in England and Denmark than Sweden.CONCLUSION: We suggest that if clear action plans, as part of safety netting, were routinely used in primary care consultations then uncertainty, false reassurance and the inefficiency and distress of multiple consultations could be reduced.
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Malmström, MarleneKarolinska Institutet,Lund University,Lunds universitet,Kirurgi, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Palliativt Utvecklingscentrum,Forskargrupper vid Lunds universitet,Surgery (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine,The Institute for Palliative Care,Lund University Research Groups,Skåne University Hospital(Swepub:lu)med-mmo
(author)
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Overgaard Nielsen, TrineAarhus University
(author)
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Evans, JulieUniversity of Oxford
(author)
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Bernhardson, Britt-MarieKarolinska Institute
(author)
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Hajdarevic, SenadaUmeå universitet,Umeå University,Institutionen för omvårdnad(Swepub:umu)seahai01
(author)
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Chapple, AlisonUniversity of Oxford
(author)
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Eriksson, Lars EKarolinska Institutet,Karolinska Institute
(author)
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Locock, LouiseUniversity of Aberdeen
(author)
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Rasmussen, BirgitLund University,Lunds universitet,Hälsofrämjande komplexa interventioner,Forskargrupper vid Lunds universitet,Palliativt Utvecklingscentrum,Health-promoting Complex Interventions,Lund University Research Groups,The Institute for Palliative Care(Swepub:lu)med-bhu
(author)
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Vedsted, PeterAarhus University
(author)
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Tishelman, CarolKarolinska Institutet,Karolinska Institute
(author)
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Andersen, Rikke SandAarhus University
(author)
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Ziebland, SueUniversity of Oxford
(author)
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University of OxfordKirurgi, Lund
(creator_code:org_t)
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In:BMJ Open: BMJ7:112044-6055
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Chapple, Alison
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