title: Symptom perceptions and help-seeking behaviour prior to lung and colorectal cancer diagnoses: a qualitative study.
abstract: BACKGROUND
  Lung and colorectal cancer are common and have high UK mortality rates. Early diagnosis is important in reducing cancer mortality, but the literature on lung and colorectal cancers suggests many people wait for a considerable time before presenting symptoms.
  
  
  OBJECTIVE
  To gain in-depth understanding of patients' interpretations of symptoms of lung and colorectal cancer prior to diagnosis, and to explore processes leading to help-seeking.
  
  
  METHODS
  Semi-structured interviews were conducted with patients diagnosed with lung (N=9) or colorectal (N=20) cancer within the previous 12 months. Patients were asked about symptoms experienced in the period preceding diagnosis, their interpretations of symptoms, and decision making for help-seeking. Thematic analysis was conducted and comparisons drawn within and across the patient groups.
  
  
  RESULTS
  Patients were proactive and rational in addressing symptoms; many developed alternative, non-cancer explanations based on their knowledge and experience. Discussions with important others frequently provided the impetus to consult, but paradoxically others often initially reinforced alternative explanations. Fear and denial did not emerge as barriers to help-seeking, but help-seeking was triggered when patients' alternative explanations could no longer be maintained, for instance due to persistence or progression of symptoms.
  
  
  CONCLUSIONS
  Patients' reasoning, decision making and interpersonal interactions prior to diagnosis were complex. Prompting patients for additional detail on symptoms within consultations could elicit critical contextual information to aid referral decisions. Findings also have implications for the design of public health campaigns.
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, s.mclachlan@keele.ac.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: McLachlan
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire.
authors.forename: Gemma
authors.initials: G
authors.lastname: Mansell
authors.affiliation: NIHR CLAHRC Yorkshire and Humber, Section of Public Health, School of Health and Related Research, University of Sheffield, Sheffield.
authors.forename: Tom
authors.initials: T
authors.lastname: Sanders
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, Central and North West London NHS Foundation Trust, London.
authors.forename: Sarah
authors.initials: S
authors.lastname: Yardley
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire.
authors.forename: Daniëlle
authors.initials: D
authors.lastname: van der Windt
authors.affiliation: School of Health Sciences and.
authors.forename: Lucy
authors.initials: L
authors.lastname: Brindle
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Chew-Graham
authors.affiliation: Primary Care and Population Sciences Division, University of Southampton, Southampton, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Little
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003657:Decision Making; D059026:Diagnostic Self Evaluation; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D063189:Symptom Assessment; D013850:Thinking
keywords: Diagnosis; neoplasms; primary health care; qualitative; referral and consultation.