title: Symptomization and triggering processes: ovarian cancer patients' narratives on pre-diagnostic sensation experiences and the initiation of healthcare seeking.
abstract: Ovarian cancer is a malignant entity typically diagnosed in advanced stages, with concomitant poor prognosis. Delayed healthcare seeking is commonly explained by the 'vague' character of the disease's symptoms combined with a lack of awareness among patients. However, research on the social contexts of ovarian cancer patients' pre-diagnostic illness experiences and healthcare seeking is scarce. To explore these topics, we initiated a qualitative interview study guided by the principles of grounded theory and based on interviews with 42 ovarian cancer patients. The study was conducted in Germany from September 2011 to February 2013. Our analysis illustrates how, in the narratives, the interviewees struggled to balance specific bodily sensations with aspects of their life-worlds prior to consulting a biomedical professional. We propose a three-phase model to capture these experiences and demonstrate how the developments of pre-diagnostic sensations were catalysed by the dynamic and complex interplay of the sensations with a variety of individual and socio-cultural factors. To conceptualize these interplays, we introduce the analytical notion of a triggering process, and we elaborate on the different ways in which such a process conditioned the transformation of a sensation into a symptom and decisions to seek healthcare. We finally discuss our findings both in relation to current research on sensations, symptoms and healthcare seeking and in their relevance for understanding diagnostic delays in ovarian cancer.
authors.affiliation: Berlin School of Public Health, Charité-Universitätsmedizin Berlin, Seestrasse. 73, 13347 Berlin, Germany. Electronic address: susanne.brandner@googlemail.com.
authors.forename: Susanne
authors.initials: S
authors.lastname: Brandner
authors.affiliation: Berlin School of Public Health, Charité-Universitätsmedizin Berlin, Seestrasse. 73, 13347 Berlin, Germany.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Müller-Nordhorn
authors.affiliation: Berlin School of Public Health, Charité-Universitätsmedizin Berlin, Seestrasse. 73, 13347 Berlin, Germany.
authors.forename: Wiebke
authors.initials: W
authors.lastname: Stritter
authors.affiliation: Department of Gynecology and Obstetrics, Charité-Universitätsmedizin Berlin, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin, Germany; Ovarian Cancer Action Research Centre, Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, United Kingdom.
authors.forename: Christina
authors.initials: C
authors.lastname: Fotopoulou
authors.affiliation: Department of Gynecology and Obstetrics, Charité-Universitätsmedizin Berlin, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin, Germany; European Competence Center for Ovarian Cancer (EKZE), Charité-Universitätsmedizin Berlin, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Jalid
authors.initials: J
authors.lastname: Sehouli
authors.affiliation: Berlin School of Public Health, Charité-Universitätsmedizin Berlin, Seestrasse. 73, 13347 Berlin, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Holmberg
mesh_terms: D000328:Adult; D000368:Aged; D001364:Awareness; D005260:Female; D005858:Germany; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D008960:Models, Psychological; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D036301:Qualitative Research
keywords: Germany; Healthcare seeking; Ovarian cancer; Sensations; Symptoms; Triggering process