title: The role of emotions in time to presentation for symptoms suggestive of cancer: a systematic literature review of quantitative studies.
abstract: BACKGROUND
  Emotions may be important in patients' decisions to seek medical help for symptoms suggestive of cancer.
  
  
  OBJECTIVE
  The aim of this systematic literature review was to examine quantitative literature on the influence of emotion on patients' help-seeking for symptoms suggestive of cancer. The objectives were to identify the following: (a) which types of emotions influence help-seeking behaviour, (b) whether these form a barrier or trigger for seeking medical help and (c) how the role of emotions varies between different cancers and populations.
  
  
  METHODS
  We searched four electronic databases and conducted a narrative synthesis. Inclusion criteria were studies that reported primary, quantitative research that examined any emotion specific to symptom appraisal or help-seeking for symptoms suggestive of cancer.
  
  
  RESULTS
  Thirty-three papers were included. The studies were heterogeneous in their methods and quality, and very few had emotion as the main focus of the research. Studies reported a limited range of emotions, mainly related to fear and worry. The impact of emotions appears mixed, sometimes acting as a barrier to consultation whilst at other times being a trigger or being unrelated to time to presentation. It is plausible that different emotions play different roles at different times prior to presentation.
  
  
  CONCLUSIONS
  This systematic review provides some quantitative evidence for the role of emotions in help-seeking behaviour. However, it also highlighted widespread methodological, definition and design issues among the existing literature. The conflicting results around the role of emotions on time to presentation may be due to the lack of definition of each specific emotion.
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Chantal
authors.initials: C
authors.lastname: Balasooriya-Smeekens
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Walter
authors.affiliation: Unit of Social and Behavioural Sciences, King's College London Dental Institute, London, UK.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Scott
mesh_terms: D004644:Emotions; D006801:Humans; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000523:psychology*