title: Help seeking for cancer 'alarm' symptoms: a qualitative interview study of primary care patients in the UK.
abstract: BACKGROUND
  Delay in help seeking for cancer 'alarm' symptoms has been identified as a contributor to delayed diagnosis.
  
  
  OBJECTIVE
  To understand people's help-seeking decision making for cancer alarm symptoms, without imposing a cancer context.
  
  
  METHODS
  Community-based, qualitative interview study in the UK, using purposive sampling by sex, socioeconomic status, and prior help seeking, with framework analysis of transcripts.
  
  
  METHODS
  Interviewees (n = 48) were recruited from a community-based sample (n = 1724) of adults aged ≥50 years who completed a health survey that included a list of symptoms. Cancer was not mentioned. Participants reporting any of 10 cancer alarm symptoms (n = 915) and who had consented to contact (n = 482) formed the potential pool from which people were invited to an interview focusing on their symptom experiences.
  
  
  RESULTS
  Reasons for help seeking included symptom persistence, social influence, awareness/fear of a link with cancer, and 'just instinct'. Perceiving the symptom as trivial or 'normal' was a deterrent, as was stoicism, adopting self-management strategies, and fear of investigations. Negative attitudes to help seeking were common. Participants did not want to be seen as making a fuss, did not want to waste the doctor's time, and were sometimes not confident that the GP could help.
  
  
  CONCLUSIONS
  Decision making about cancer alarm symptoms was complex. Recognition of cancer risk almost always motivated help seeking (more so than the fear of cancer being a deterrent), assisted by recent public-awareness campaigns. As well as symptom persistence motivating help seeking, it could also have the reverse effect. Negative attitudes to help seeking were significant deterrents.
authors.affiliation: School of Health Sciences, University of Surrey, Guildford.
authors.forename: Katriina L
authors.initials: KL
authors.lastname: Whitaker
authors.affiliation: Hull York Medical School, Hull.
authors.forename: Una
authors.initials: U
authors.lastname: Macleod
authors.affiliation: Health Behaviour Research Centre, University College London, London.
authors.forename: Kelly
authors.initials: K
authors.lastname: Winstanley
authors.affiliation: Unit of Social and Behavioural Sciences, King's College London Dental Institute, London.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Scott
authors.affiliation: Health Behaviour Research Centre, University College London, London.
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D057210:Delayed Diagnosis; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys / Q000592:standards*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care; D036301:Qualitative Research; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology
keywords: awareness; cancer; fear; general practice; help-seeking; ‘alarm’ symptoms