title: Unintended consequences of an 'all-clear' diagnosis for potential cancer symptoms: a nested qualitative interview study with primary care patients.
abstract: BACKGROUND
  Nine out of 10 patients undergoing urgent cancer investigations receive an 'all-clear' diagnosis.
  
  
  OBJECTIVE
  A qualitative approach was used to evaluate the impact of investigations that did not result in cancer diagnosis on subsequent symptom attribution and help seeking for recurrent or new possible cancer symptoms.
  
  
  METHODS
  A survey of symptoms, help seeking, and past investigations was sent to 4913 individuals aged ≥50 years from four UK general practices. Of 2042 responders, 62 participants were recruited still reporting at least one cancer 'alarm' symptom in a 3-month follow-up survey for a nested in-depth interview study (ensuring variation in sociodemographic characteristics).
  
  
  METHODS
  Framework analysis was used to examine the in-depth semi-structured interviews and identify themes related to previous health investigations.
  
  
  RESULTS
  Interviewees were on average 65 years old, and 90% reported investigations within the previous 2 years. Most often they reported gastrointestinal, urinary, and respiratory symptoms, and 42% had waited ≥3 months before help seeking. Reassurance from a previous non-cancer diagnosis explained delays in help seeking even if symptoms persisted or new symptoms developed months or years later. Others were worried about appearing hypochondriacal or that they would not be taken seriously if they returned to the doctor.
  
  
  CONCLUSIONS
  An all-clear diagnosis can influence help seeking for months or even years in case of new or recurrent alarm symptoms. Considering the increasing number of people undergoing investigations and receiving an all-clear, it is paramount to limit unintended consequences by providing appropriate information and support. Specific issues are identified that could be addressed.
authors: Health Behaviour Research Centre, University College London, London.
authors: Cristina
authors: C
authors: Renzi
authors: School of Health Sciences, University of Surrey, Guildford.
authors: Katriina L
authors: KL
authors: Whitaker
authors: Health Behaviour Research Centre, University College London, London.
authors: Kelly
authors: K
authors: Winstanley
authors: Health Behaviour Research Centre, University College London, London.
authors: Susanne
authors: S
authors: Cromme
authors: Health Behaviour Research Centre, University College London, London.
authors: Jane
authors: J
authors: Wardle
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology* / Q000523:psychology; D057210:Delayed Diagnosis; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000706:statistics & numerical data; D036301:Qualitative Research; D012196:Review Literature as Topic; D063189:Symptom Assessment; D035501:Uncertainty; D006113:United Kingdom / Q000453:epidemiology
keywords: cancer; delay; diagnosis; diagnostic investigations; help seeking; symptoms