title: A qualitative exploration of the use of calendar landmarking instruments in cancer symptom research.
abstract: BACKGROUND
  Late diagnosis is considered to be a major factor contributing to poorer cancer survival rates in the UK. Interventions have focussed on the promotion of earlier diagnosis in patients with potential cancer symptoms. However, to assess the effectiveness of these interventions, the time from symptom onset to presentation needs to be reliably and accurately measured. This qualitative study explored the use of calendar landmarking instruments in cancer symptom research.
  
  
  METHODS
  We performed a secondary analysis of transcripts of interviews using the calendar landmarking instrument, undertaken with patients who had either been diagnosed with cancer (n = 40, IRCO study, Western Australia), or who had symptoms suggestive of cancer (n = 38, SYMPTOM study, North East and Eastern England). We used constant comparison methods to identify use of the calendar landmarking instruments and the impact of their application.
  
  
  RESULTS
  The calendar landmarking instrument appeared to help many patients, either by acting as a prompt or helping to refine recall of events. A combination of personal (e.g. birthday) and national (e.g. Christmas) landmarks seemed to be the most effective. Calendar landmarking instruments appeared more useful where the time period between onset of symptoms and date of first consultation was less than three months. The interviewee's age, gender and cancer type did not appear to influence whether or not the instrument facilitated recall, and there were no instances where the use of the instrument resulted in the disclosure of a new first symptom. Symptoms of similar chronic conditions could create difficulties when applying the instrument; it was difficult for these participants to characterise and disentangle their symptoms which prompted their decisions to seek help. Some participants tended to prefer to use their own, already personalised, diaries to assist in their recall of events.
  
  
  CONCLUSIONS
  This study is the first to describe the potential role of calendar landmarking instruments to support research interviews which explore symptoms and events along the cancer diagnostic pathway. The major challenge remains as to whether they actually improve accuracy of recall.
authors.forename: Katie
authors.initials: K
authors.lastname: Mills
authors.forename: Jon
authors.initials: J
authors.lastname: Emery
authors.forename: Camilla
authors.initials: C
authors.lastname: Cheung
authors.forename: Nicola
authors.initials: N
authors.lastname: Hall
authors.forename: Linda
authors.initials: L
authors.lastname: Birt
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Walter
mesh_terms: D001315:Australia; D001943:Breast Neoplasms / Q000175:diagnosis; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000175:diagnosis; D003463:Cues; D057210:Delayed Diagnosis / Q000517:prevention & control*; D004739:England; D005260:Female; D006693:Holidays; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis*; D010190:Pancreatic Neoplasms / Q000175:diagnosis; D011471:Prostatic Neoplasms / Q000175:diagnosis; D036301:Qualitative Research; D057566:Self Report; D013997:Time Factors