Original Article
Help-seeking experiences of men diagnosed with colorectal cancer: a qualitative study
D.V. Oberoi MBBS,
M. Jiwa MA, MD, FRACGP, FRCP,
A. McManus MPH, PhD, PGDipPH, BScHP (H.Biol),
R. Hodder MBChB, MD, FRCS, FRACS,
J. de Nooijer M.Sc. PhD,
Corresponding Author
D.V. Oberoi MBBS
PhD Candidate
Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
Correspondence address: Devesh V. Oberoi, Faculty of Health Sciences, Curtin University, 7 Parker Place, Bentley, WA 6102, Australia (e-mail: [email protected])Search for more papers by this authorM. Jiwa MA, MD, FRACGP, FRCP
Professor
Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
Search for more papers by this authorA. McManus MPH, PhD, PGDipPH, BScHP (H.Biol)
Professor
Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
Search for more papers by this authorR. Hodder MBChB, MD, FRCS, FRACS
Consultant Surgeon
Department of General Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
Search for more papers by this authorJ. de Nooijer M.Sc. PhD
Associate Professor
Faculty of Health Sciences, Maastricht University, Maastricht, the Netherlands
Search for more papers by this authorD.V. Oberoi MBBS,
M. Jiwa MA, MD, FRACGP, FRCP,
A. McManus MPH, PhD, PGDipPH, BScHP (H.Biol),
R. Hodder MBChB, MD, FRCS, FRACS,
J. de Nooijer M.Sc. PhD,
Corresponding Author
D.V. Oberoi MBBS
PhD Candidate
Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
Correspondence address: Devesh V. Oberoi, Faculty of Health Sciences, Curtin University, 7 Parker Place, Bentley, WA 6102, Australia (e-mail: [email protected])Search for more papers by this authorM. Jiwa MA, MD, FRACGP, FRCP
Professor
Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
Search for more papers by this authorA. McManus MPH, PhD, PGDipPH, BScHP (H.Biol)
Professor
Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
Search for more papers by this authorR. Hodder MBChB, MD, FRCS, FRACS
Consultant Surgeon
Department of General Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
Search for more papers by this authorJ. de Nooijer M.Sc. PhD
Associate Professor
Faculty of Health Sciences, Maastricht University, Maastricht, the Netherlands
Search for more papers by this authorAbstract
Advanced-stage diagnosis of colorectal cancer (CRC) leads to poor prognosis and reduced survival rates. The current study seeks to explore the reasons for diagnostic delays in a sample of Australian men with CRC. Semi-structured interviews were conducted in a purposive sample of 20 male CRC patients. Data collection ceased when no new data emerged. Interviews were audiotaped, transcribed and thematically analysed using Andersen's Model of Total Patient Delay as the theoretical framework. Most participants (18/20) had experienced lower bowel symptoms prior to diagnosis. Patient-related delays were more common than delays attributable to the health-care system. Data regarding patient delays fit within the first four stages of Andersen's model. The barriers to seeking timely medical advice were mainly attributed to misinterpretation of symptoms, fear of cancer diagnosis, reticence to discuss the symptoms or consulting a general practitioner. Treatment delays were a minor cause for delayed diagnosis. Delay in referral and scheduling for colonoscopy were among the system-delay factors. In many instances, delays resulted from men's failure to attribute their symptoms to cancer and, subsequently, delay in diagnosis.
References
- Adelstein B.-A., Macaskill P., Chan S., Katelaris P. & Irwig L. (2011) Most bowel cancer symptoms do not indicate colorectal cancer and polyps: a systematic review. BMC Gastroenterology 11, 65.
- Adelstein B.-A., Macaskill P., Turner R.M. & Irwig L. (2012) Patients who take their symptoms less seriously are more likely to have colorectal cancer. BMC Gastroenterology 12, 130.
- Andersen B.L. & Cacioppo J.T. (1995) Delay in seeking a cancer diagnosis: delay stages and psychophysiological comparison processes. The British Journal of Social Psychology 34 (Pt 1), 33–52.
- Astin M., Griffin T., Neal R.D., Rose P. & Hamilton W. (2011) The diagnostic value of symptoms for colorectal cancer in primary care: a systematic review. The British Journal of General Practice 61, e231–e243.
- Australian Institute of Health and Welfare (2012) Cancer in Australia: an overview, 2012. Cancer series no. 74. Cat. no. CAN 70, Canberra. Available at: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129542353
- Bain N.S., Campbell N.C., Ritchie L.D. & Cassidy J. (2002) Striking the right balance in colorectal cancer care – a qualitative study of rural and urban patients. Family Practice 19, 369–374.
- Bish A., Ramirez A., Burgess C. & Hunter M. (2005) Understanding why women delay in seeking help for breast cancer symptoms. Journal of Psychosomatic Research 58, 321–326.
- Burgess C., Potts H., Hamed H., Bish A., Hunter M., Richards M. & Ramirez A. (2006) Why do older women delay presentation with breast cancer symptoms? Psycho-Oncology 15, 962–968.
- Byles J.E., Redman S., Hennrikus D., Sanson-Fisher R.W. & Dickinson J. (1992) Delay in consulting a medical practitioner about rectal bleeding. Journal of Epidemiology and Community Health 46, 241–244.
- Chou C.L., Weng S.F., Lin J.K. & Chang S.C. (2013) Role for gender in colorectal cancer risk: a Taiwan population-based study. International Journal of Colorectal Disease 28, 1001–1008.
- Cockburn J., Paul C., Tzelepis F., McElduff P. & Byles J. (2003) Delay in seeking advice for symptoms that potentially indicate bowel cancer. American Journal of Health Behavior 27, 401–407.
- Courtney R., Paul C., Sanson-Fisher R., Macrae F., Attia J. & McEvoy M. (2012) Current state of medical-advice-seeking behaviour for symptoms of colorectal cancer: determinants of failure and delay in medical consultation. Colorectal Disease 14, e222–e229.
- De Nooijer J., Lechner L. & De Vries H. (2001a) Help-seeking behaviour for cancer symptoms: perceptions of patients and general practitioners. Psycho-Oncology 10, 469–478.
- De Nooijer J., Lechner L. & De Vries H. (2001b) A qualitative study on detecting cancer symptoms and seeking medical help; an application of Andersen's Model of total patient delay. Patient Education and Counseling 42, 145–157.
- Esteva M., Leiva A., Ramos M., Pita-Fernández S., González-Luján L., Casamitjana M., Sánchez M.A., Pértega-Díaz S., Ruiz A. & Gonzalez-Santamaría P. (2013) Factors related with symptom duration until diagnosis and treatment of symptomatic colorectal cancer. BMC Cancer 13, 87.
- Evans J., Ziebland S. & McPherson A. (2007) Minimizing delays in ovarian cancer diagnosis: an expansion of Andersen's model of ‘total patient delay’. Family Practice 24, 48–55.
- Evans R.E., Brotherstone H., Miles A. & Wardle J. (2005) Gender differences in early detection of cancer. Journal of Men's Health and Gender 2, 209–217.
10.1016/j.jmhg.2004.12.012 Google Scholar
- Ferlay J., Soerjomataram I., Ervik M., Dikshit R., Eser S., Mathers C., Rebelo M., Parkin D., Forman D. & Bray F. (2014) GLOBOCAN 2012 v1. 0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer; 2013.
- Gonzalez-Hermoso F., Perez-Palma J., Marchena-Gomez J., Lorenzo-Rocha N. & Medina-Arana V. (2004) Can early diagnosis of symptomatic colorectal cancer improve the prognosis? World Journal of Surgery 28, 716–720.
- Guile K. & Nicholson S. (2004) Does knowledge influence melanoma-prone behavior? Awareness, exposure, and sun protection among five social groups. Oncology Nursing Forum 31, 641–646.
- Hamilton W. & Sharp D. (2004) Diagnosis of colorectal cancer in primary care: the evidence base for guidelines. Family Practice 21, 99–106.
- Hashim S.M., Fah T.S., Omar K., Radzniwan M., Rashid A., Shah S.A. & Sagap I. (2007) Knowledge of colorectal cancer among patients presenting with rectal bleeding and its association with delay in seeking medical advice. Asian Pacific Journal of Cancer Prevention 12, 2007–2011.
- Jellema P., Van Der Windt D.A., Bruinvels D.J., Mallen C.D., Van Weyenberg S.J., Mulder C.J. & De Vet H.C. (2010) Value of symptoms and additional diagnostic tests for colorectal cancer in primary care: systematic review and meta-analysis. BMJ (Clinical Research Ed.) 340, c1269.
- Langenbach M.R., Schmidt J., Neumann J. & Zirngibl H. (2003) Delay in treatment of colorectal cancer: multifactorial problem. World Journal of Surgery 27, 304–308.
- Lynch B.M., Baade P., Fritschi L., Leggett B., Owen N., Pakenham K., Newman B. & Aitken J.F. (2007) Modes of presentation and pathways to diagnosis of colorectal cancer in Queensland. Medical Journal of Australia 186, 288–291.
- Macleod U., Mitchell E., Burgess C., Macdonald S. & Ramirez A. (2009) Risk factors for delayed presentation and referral of symptomatic cancer: evidence for common cancers. British Journal of Cancer 101, S92–S101.
- McArdle C.S., McMillan D.C. & Hole D.J. (2003) Male gender adversely affects survival following surgery for colorectal cancer. British Journal of Surgery 90, 711–715.
- McDermott F., Hughes E., Pihl E., Milne B. & Price A. (1981) Symptom duration and survival prospects in carcinoma of the rectum. Surgery, Gynecology & Obstetrics 153, 321–326.
- Mitchell E., Macdonald S., Campbell N., Weller D. & Macleod U. (2007) Influences on pre-hospital delay in the diagnosis of colorectal cancer: a systematic review. British Journal of Cancer 98, 60–70.
- Molassiotis A., Wilson B., Brunton L. & Chandler C. (2010) Mapping patients' experiences from initial change in health to cancer diagnosis: a qualitative exploration of patient and system factors mediating this process. European Journal of Cancer Care 19, 98–109.
- Neal R. & Allgar V. (2005) Sociodemographic factors and delays in the diagnosis of six cancers: analysis of data from the ‘National Survey of NHS Patients: Cancer’. British Journal of Cancer 92, 1971–1975.
- Oberoi D.V., Jiwa M., McManus A. & Hodder R. (2014) Colorectal cancer: applying a gender lens. Quality in Primary Care 22, 71–79.
- Oberoi D.V., Jiwa M., McManus A. & Hodder R. (2015a) Barriers to help seeking in men diagnosed with benign colorectal diseases. American Journal of Health Behavior 39, 22–33.
- Oberoi D.V., Jiwa M., McManus A. & Hodder R. (2015b) Men's help seeking behaviour with regards to lower bowel symptoms. American Journal of Health Behavior 39, 211–220 (in press).
- Pack G.T. & Gallo J.S. (1938) The culpability for delay in the treatment of cancer. The American Journal of Cancer 33, 443–462.
- Pedersen A.F., Hansen R.P. & Vedsted P. (2013) Patient delay in colorectal cancer patients: associations with rectal bleeding and thoughts about cancer. PLoS ONE 8, e69700.
- Ramos M., Arranz M., Taltavull M., March S., Cabeza E. & Esteva M. (2010) Factors triggering medical consultation for symptoms of colorectal cancer and perceptions surrounding diagnosis. European Journal of Cancer Care 19, 192–199.
- Ristvedt S.L. & Trinkaus K.M. (2005) Psychological factors related to delay in consultation for cancer symptoms. Psycho-Oncology 14, 339–350.
- Robertson R., Campbell N., Smith S., Donnan P., Sullivan F., Duffy R., Ritchie L., Millar D., Cassidy J. & Munro A. (2004) Factors influencing time from presentation to treatment of colorectal and breast cancer in urban and rural areas. British Journal of Cancer 90, 1479–1485.
- Roncoroni L., Pietra N., Violi V., Sarli L., Choua O. & Peracchia A. (1999) Delay in the diagnosis and outcome of colorectal cancer: a prospective study. European Journal of Surgical Oncology 25, 173–178.
- Siminoff L.A., Rogers H.L., Thomson M.D., Dumenci L. & Harris-Haywood S. (2011) Doctor, what's wrong with me? Factors that delay the diagnosis of colorectal cancer. Patient Education and Counseling 84, 352–358.
- Singh S., Morgan M.B., Broughton M., Caffarey S., Topham C. & Marks C.G. (1995) A 10-year prospective audit of outcome of surgical treatment for colorectal carcinoma. The British Journal of Surgery 82, 1486–1490.
- Sladden M.J. & Thomson A.N. (1998) How do general practitioners manage rectal bleeding? Australian Family Physician 27, 78–82.
- Smith L.K., Pope C. & Botha J.L. (2005) Patients' help-seeking experiences and delay in cancer presentation: a qualitative synthesis. The Lancet 366, 825–831.
- Talley N.J. & Jones M. (1998) Self-reported rectal bleeding in a United States community: prevalence, risk factors, and health care seeking. The American Journal of Gastroenterology 93, 2179–2183.
- Thompson M.R., Heath I., Swarbrick E.T., Wood L.F. & Ellis B.G. (2011) Earlier diagnosis and treatment of symptomatic bowel cancer: can it be achieved and how much will it improve survival? Colorectal Disease 13, 6–16.
- Tomlinson C., Wong C., Au H.-J. & Schiller D. (2012) Factors associated with delays to medical assessment and diagnosis for patients with colorectal cancer. Canadian Family Physician 58, e495–e501.
- Tørring M.L., Frydenberg M., Hamilton W., Hansen R.P., Lautrup M.D. & Vedsted P. (2012) Diagnostic interval and mortality in colorectal cancer: U-shaped association demonstrated for three different datasets. Journal of Clinical Epidemiology 65, 669–678.
- Walter F., Webster A., Scott S. & Emery J. (2012) The Andersen Model of Total Patient Delay: a systematic review of its application in cancer diagnosis. Journal of Health Services Research & Policy 17, 110–118.
- Weitzman E.R., Zapka J., Estabrook B. & Goins K.V. (2001) Risk and reluctance: understanding impediments to colorectal cancer screening. Preventive Medicine 32, 502–513.
- Wichmann M., Müller C., Hornung H., Lau-Werner U. & Schildberg F. (2001) Gender differences in long-term survival of patients with colorectal cancer. British Journal of Surgery 88, 1092–1098.
- Young C.J., Sweeney J.L. & Hunter A. (2000) Implications of delayed diagnosis in colorectal cancer. Australian and New Zealand Journal of Surgery 70, 635–638.
