title: Over-reassurance and undersupport after a 'false alarm': a systematic review of the impact on subsequent cancer symptom attribution and help seeking.
abstract: OBJECTIVE
  This literature review examined research into the impact of a previous 'all-clear' or non-cancer diagnosis following symptomatic presentation ('false alarm') on symptom attribution and delays in help seeking for subsequent possible cancer symptoms.
  
  
  METHODS
  The comprehensive literature review included original research based on quantitative, qualitative and mixed data collection methods. We used a combination of search strategies, including in-depth searches of electronic databases (PubMed, EMBASE, PsychInfo), searching key authors and articles listed as 'related' in PubMed, and reference lists. We performed a narrative synthesis of key themes shared across studies.
  
  
  METHODS
  The review included studies published after 1990 and before February 2014 reporting information on adult patients having experienced a false alarm following symptomatic presentation. We excluded false alarms in the context of screening.
  
  
  METHODS
  We evaluated the effect of a 'false alarm' on symptom attribution and help seeking for new or recurrent possible cancer symptoms.
  
  
  RESULTS
  Overall, 1442 papers were screened and 121 retrieved for full-text evaluation. Among them, 19 reported on false alarms and subsequent symptom attribution or help seeking. They used qualitative (n=14), quantitative (n=3) and mixed methods (n=2). Breast (n=7), gynaecological (n=3), colorectal (n=2), testicular (n=2), and head and neck cancers (n=2) were the most studied. Two broad themes emerged underlying delays in help seeking: (1) over-reassurance from the previous 'all-clear' diagnosis leading to subsequent symptoms being interpreted as benign, and (2) unsupportive healthcare experiences in which symptoms were dismissed, leaving patients concerned about appearing hypochondriacal or uncertain about the appropriate next actions. The evidence suggested that the effect of a false alarm can persist for months and even years.
  
  
  CONCLUSIONS
  In conclusion, over-reassurance and undersupport of patients after a false alarm can undermine help seeking in the case of new or recurrent potential cancer symptoms, highlighting the need for appropriate patient information when investigations rule out cancer.
authors: Department of Epidemiology and Public Health, University College London, Health Behaviour Research Centre, London, UK.
authors: Cristina
authors: C
authors: Renzi
authors: Department of Epidemiology and Public Health, University College London, Health Behaviour Research Centre, London, UK.
authors: Katriina L
authors: KL
authors: Whitaker
authors: Department of Epidemiology and Public Health, University College London, Health Behaviour Research Centre, London, UK.
authors: Jane
authors: J
authors: Wardle
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D009369:Neoplasms / Q000150:complications; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D035501:Uncertainty
keywords: GENERAL MEDICINE (see Internal Medicine); ONCOLOGY; PRIMARY CARE; PUBLIC HEALTH; QUALITATIVE RESEARCH
references: Am J Prev Med. 1990 Mar-Apr;6(2):84-92
references: 2363954
references: Cancer Causes Control. 2010 Jun;21(6):945-58
references: 20177964
references: Breast J. 2006 Sep-Oct;12(5):413-7
references: 16958957
references: Psychoneuroendocrinology. 2007 Jan;32(1):22-35
references: 17092654
references: BMJ Open. 2012 Nov 12;2(6):
references: 23148341
references: BMC Health Serv Res. 2006 Apr 03;6:43
references: 16584544
references: Br J Gen Pract. 2011 Aug;61(589):e508-12
references: 21801563
references: Colorectal Dis. 2013 Mar;15(3):292-7
references: 22776207
references: Br J Gen Pract. 2004 Jan;54(498):25-32
references: 14965403
references: Soc Sci Med. 2012 Nov;75(10):1753-61
references: 22884943
references: Br J Cancer. 2009 Dec 3;101 Suppl 2:S18-23
references: 19956158
references: Curr Oncol. 2011 Oct;18(5):e227-37
references: 21980254
references: Br J Cancer. 2006 May 8;94(9):1272-80
references: 16622459
references: J Pain Symptom Manage. 2010 Oct;40(4):545-58
references: 20579839
references: Cancer Epidemiol Biomarkers Prev. 2011 Oct;20(10):2127-31
references: 21876191
references: J Psychosom Res. 2007 Jun;62(6):621-30
references: 17540219
references: Fam Pract. 2005 Oct;22(5):554-9
references: 16006495
references: Breast Cancer Res Treat. 2011 May;127(1):229-31
references: 21052828
references: Br J Cancer. 2009 Dec 3;101 Suppl 2:S92-S101
references: 19956172
references: J Adv Nurs. 2010 Nov;66(11):2372-90
references: 21039773
references: Fam Pract. 2007 Feb;24(1):48-55
references: 17158183
references: Ann Intern Med. 2007 Apr 3;146(7):502-10
references: 17404352
references: Health Technol Assess. 2013 Mar;17(13):1-170, v-vi
references: 23540978
references: Br J Gen Pract. 2006 May;56(526):355-62
references: 16638251
references: Am J Surg. 2010 Dec;200(6):712-7; discussion 717-8
references: 21146009
references: Br J Cancer. 2009 Dec 3;101 Suppl 2:S125-9
references: 19956156
references: Br J Cancer. 2009 Dec 3;101 Suppl 2:S1-4
references: 19956152
references: J Clin Oncol. 2003 Apr 15;21(8):1440-6
references: 12697864
references: Curr Oncol. 2012 Jun;19(3):e191-200
references: 22670109
references: J Public Health (Oxf). 2010 Dec;32(4):565-71
references: 20154063
references: Psychooncology. 2005 Nov;14(11):917-38
references: 15786514
references: Br J Health Psychol. 2013 Feb;18(1):45-65
references: 22536840
references: Int J Public Health. 2010 Oct;55(5):459-68
references: 20467882
references: Br J Cancer. 2007 Dec 17;97(12):1632-41
references: 18000508
references: Patient Educ Couns. 2011 Sep;84(3):352-8
references: 21621950
references: Lancet. 1999 Apr 3;353(9159):1119-26
references: 10209974
references: Health Psychol. 2002 Sep;21(5):485-94
references: 12211516
references: Fam Pract. 1999 Apr;16(2):143-8
references: 10381020
references: Int J Nurs Stud. 2012 Jan;49(1):47-53
references: 21835406
references: Prev Med. 2004 Jun;38(6):723-31
references: 15193892
references: Br J Cancer. 2008 Jan 15;98(1):60-70
references: 18059401
references: Oncol Nurs Forum. 1994 Jan-Feb;21(1):47-52
references: 8140001
references: Br J Gen Pract. 2011 May;61(586):317-8
references: 21619755
references: BMJ. 2005 Nov 5;331(7524):1064-5
references: 16230312
references: Br J Gen Pract. 2011 Nov;61(592):e700-6
references: 22054333
references: Evid Based Med. 2013 Apr;18(2):54-61
references: 22859786
references: Br J Cancer. 2013 Feb 5;108(2):292-300
references: 23370208
references: Am J Med. 2008 May;121(5 Suppl):S2-23
references: 18440350
references: Cancer Pract. 1995 Jul-Aug;3(4):219-25
references: 7620486
references: Lancet. 2011 Jan 8;377(9760):127-38
references: 21183212
references: Int J Health Care Qual Assur. 2012;25(1):75-85
references: 22455010
references: Can Oncol Nurs J. 2002 Summer;12(3):152-68
references: 12271917
references: Br J Gen Pract. 2009 Nov;59(568):872-4; discussion 874
references: 19861036
references: Colorectal Dis. 2014 Aug;16(8):616-9
references: 24629037
references: Fam Pract. 2002 Aug;19(4):369-74
references: 12110557
references: Scand J Prim Health Care. 2013 Dec;31(4):209-14
references: 24191847
references: Psychooncology. 1999 Mar-Apr;8(2):144-54
references: 10335558
references: J Clin Epidemiol. 2013 Nov;66(11):1230-43
references: 23953082
references: Br J Cancer. 2002 Apr 8;86(7):1034-40
references: 11953844
references: Qual Health Res. 1998 Jan;8(1):48-60
references: 10558326
references: Am J Gastroenterol. 2013 Aug;108(8):1341-3
references: 23912407
references: Br J Gen Pract. 2013 Jan;63(606):e37-46
references: 23336459
references: J Obstet Gynaecol. 2013 Feb;33(2):184-7
references: 23445145
references: Br J Gen Pract. 2013 Jan;63(606):e30-6
references: 23336455
references: Lancet Oncol. 2007 Sep;8(9):773-83
references: 17714991
references: Soc Sci Med. 2006 Dec;63(12):3137-49
references: 16996669
references: Lancet. 2005 Sep 3-9;366(9488):825-31
references: 16139657