Diagnosing cancer in the bush: a mixed-methods study of symptom appraisal and help-seeking behaviour in people with cancer from rural Western Australia.
BACKGROUND
Previous studies have focused on the treatment received by rural cancer patients and have not examined their diagnostic pathways as reasons for poorer outcomes in rural Australia.


OBJECTIVE
To compare and explore symptom appraisal and help-seeking behaviour in patients with breast, lung, prostate or colorectal cancer from rural Western Australia (WA).


METHODS
A mixed-methods study of people recently diagnosed with breast, lung, prostate or colorectal cancer from rural WA. The time from first symptom to diagnosis (i.e. total diagnostic interval, TDI) was calculated from interviews and medical records.


RESULTS
Sixty-six participants were recruited (24 breast, 20 colorectal, 14 prostate and 8 lung cancer patients). There was a highly significant difference in time from symptom onset to seeking help between cancers (P = 0.006). Geometric mean symptom appraisal for colorectal cancer was significantly longer than that for breast and lung cancers [geometric mean differences: 2.58 (95% confidence interval, CI: 0.64-4.53), P = 0.01; 3.97 (1.63-6.30), P = 0.001, respectively]. There was a significant overall difference in arithmetic mean TDI (P = 0.046); breast cancer TDI was significantly shorter than colorectal or prostate cancer TDI [mean difference : 266.3 days (95% CI: 45.9-486.8), P = 0.019; 277.0 days, (32.1-521.9), P = 0.027, respectively]. These differences were explained by the nature and personal interpretation of symptoms, perceived as well as real problems of access to health care, optimism, stoicism, machismo, fear, embarrassment and competing demands.


CONCLUSIONS
Longer symptom appraisal was observed for colorectal cancer. Participants defined core characteristics of rural Australians as optimism, stoicism and machismo. These features, as well as access to health care, contribute to later presentation of cancer.
School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, Australia. jon.emery@uwa.edu.au
Jon D
JD
Emery
Fiona M
FM
Walter
Vicky
V
Gray
Craig
C
Sinclair
Denise
D
Howting
Max
M
Bulsara
Caroline
C
Bulsara
Andrew
A
Webster
Kirsten
K
Auret
Christobel
C
Saunders
Anna
A
Nowak
C D'Arcy
CD
Holman
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D057210:Delayed Diagnosis / Q000523:psychology*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012424:Rural Population; D014904:Western Australia
Breast cancer; colorectal cancer; lung cancer; primary care; prostate cancer; rural health.