title: Factors associated with delayed patient appraisal of colorectal cancer symptoms.
abstract: OBJECTIVE
  To evaluate the relationship between symptoms, financial and cognitive barriers with patient delays in seeking evaluation of symptoms.
  
  
  METHODS
  Data were collected from 252 colorectal cancer patients from academic and community oncology practices in Virginia and Ohio. We used a cross-sectional, mixed methods design collected data through patient interviews and medical record reviews. Structural equation modeling (SEM) tested the hypothesized relationships between symptoms, financial and cognitive barriers and patient care seeking delays.
  
  
  RESULTS
  In bivariate analyses, patients who reported a financial barrier to accessing health care (t (246) = -2.6, p < 0.01) were more likely to have greater care-seeking delays. Model testing revealed that experiencing cognitive barriers was a significant, positive, direct predictor of appraisal delay (0.35; p < 0.01). Indirect pathways from symptoms (0.07; p < 0.05) and financial barriers (0.09; p < 0.05) to appraisal delay via cognitive barriers were significant.
  
  
  CONCLUSIONS
  Patient interpretations of symptoms were influenced by financial barriers. Conceptualizing financial barriers as a component of the symptom appraisal process is conceptually different from viewing it as only a structural barrier preventing healthcare access. Implications for practice These findings extend our understanding of why and how patients seemingly ignore serious symptoms, which hamper physician ability to provide curative therapy. In addition to uninsured patients, this may have important implications for the treatment and care of those who are underinsured.
authors.affiliation: College Health Professions & Social Work, Jones Hall 302, Philadelphia, PA, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Siminoff
authors.forename: Maria
authors.initials: M
authors.lastname: Thomson
authors.forename: Levent
authors.initials: L
authors.lastname: Dumenci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000628:therapy; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000191:economics*; D055088:Early Detection of Cancer / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009820:Ohio; D010342:Patient Acceptance of Health Care; D012959:Socioeconomic Factors; D013997:Time Factors; D014768:Virginia
keywords: appraisal delay; cognitive barriers; colorectal cancer; financial barriers