title: The signs, symptoms and help-seeking experiences of neutropenic sepsis patients before they reach hospital: a qualitative study.
abstract: OBJECTIVE
  Neutropenic sepsis (NS) is a medical emergency in which urgent treatment with antibiotics is known to improve outcomes, yet there are minimal data about what happens to patients with NS before they reach hospital. We aimed to examine the pre-hospital experiences of patients with NS, identifying its early presenting features and exploring the factors potentially delaying patients' arrival at hospital.
  
  
  METHODS
  We conducted in-depth, qualitative interviews with 22 cancer patients admitted to hospital for treatment of NS and 10 patient carers. The setting was a tertiary referral centre in Southern England.
  
  
  RESULTS
  Thirty seven percent of patients took over 12 h to present to hospital after symptom onset. The mean delay in presentation was 11 h (range 0-68 h). Thematic analysis of the interviews, using grounded theory, revealed wide-ranging, potentially modifiable factors delaying patients' presentation to hospital. For example, information provided to patients about NS from different sources was inconsistent, with 'mixed messages' about urgency triggering delays. All patients self-monitored their temperature and understood the implication of a fever but few appreciated the potential significance of feeling unwell in the absence of fever. Attempts to obtain treatment were sometimes thwarted by nonspecialists' failure to recognise possible neutropenia in a patient with apparently mild signs, and several patients with NS were discharged without treatment. Some patients denied their symptoms to themselves and others to avoid hospital admission; palliative patients seemed particularly prone to these attitudes, while their carers were keen to seek medical attention.
  
  
  CONCLUSIONS
  This investigation of patients' and carers' experiences of NS identifies numerous strategies for improving patient education, support and pre-hospital management, all of which may reduce pre-hospital delays and consequently decrease morbidity and mortality from NS.
authors: Department of Haematology, Cancer and Haematology Centre, Churchill Hospital, OX3 7LE, Oxford, UK, rtsclarke@gmail.com.
authors: Rachel T
authors: RT
authors: Clarke
authors: Sarah
authors: S
authors: Bird
authors: Isona
authors: I
authors: Kakuchi
authors: Tim J
authors: TJ
authors: Littlewood
authors: Victoria
authors: V
authors: van Hamel Parsons
mesh_terms: D000328:Adult; D000368:Aged; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D004636:Emergency Service, Hospital; D004739:England; D005260:Female; D000066505:Help-Seeking Behavior; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D010343:Patient Admission; D010351:Patient Discharge; D036301:Qualitative Research; D018805:Sepsis / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D011795:Surveys and Questionnaires