title: 'Containment' as an analytical framework for understanding patient delay: a qualitative study of cancer patients' symptom interpretation processes.
abstract: Recent decades have seen much variation in survival and mortality among European cancer patients, with rather small increases in survival, especially among patients in UK and Denmark. This poor outcome has been ascribed tentatively to patient delay since an estimated 20-25% of all cancer patients report having experienced cancer-related symptoms for more than three months before seeking care. In this article we analyse semi-structured interviews with 30 adult Danish cancer patients and their families. Special focus is given to symptom interpretation processes, and how these processes potentially delay care-seeking decisions. The paper adopts a contextual approach inspired mainly by the sociologist Alonzo's (1979, 1984) concept of containment. Alonzo's theory is supplemented with recent anthropological and sociological literature on how people establish the relation between bodily sensations and symptoms and decide how to respond adequately to these. We present an analysis illustrating that bodily sensations and symptoms are potentially contained in a dynamic interplay of factors related to specific social situations, life biographies and life expectations and their accordance with culturally acceptable values and explanations. Finally, we discuss the implications of the analysis for future studies on patient delay.
authors.affiliation: Research Unit for General Practice, Department of Public Health, University of Aarhus, Bartholins Alle 2, 8000 Århus, Denmark. Electronic address: rsa@alm.au.dk.
authors.forename: Rikke Sand
authors.initials: RS
authors.lastname: Andersen
authors.affiliation: Department of Anthropology, Archeology and Linguistics, University of Aarhus, Denmark.
authors.forename: Bjarke
authors.initials: B
authors.lastname: Paarup
authors.affiliation: Research Unit for General Practice, Department of Public Health, University of Aarhus, Bartholins Alle 2, 8000 Århus, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
authors.affiliation: Research Unit for General Practice, Department of Public Health, University of Aarhus, Bartholins Alle 2, 8000 Århus, Denmark.
authors.forename: Flemming
authors.initials: F
authors.lastname: Bro
authors.affiliation: The Research Unit for Family Medicine, Institute of Health Services Research, University of Southern Denmark, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Soendergaard
mesh_terms: D000368:Aged; D003718:Denmark; D005190:Family / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008606:Mental Processes; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D036301:Qualitative Research; D013997:Time Factors