title: Avoidant conversations about death by clinicians cause delays in reporting of neutropenic sepsis: Grounded theory study.
abstract: BACKGROUND
  Evidence suggests that patients delay reporting symptoms of neutropenic sepsis (NS) despite the risk to their life. This study aimed to elicit factors that contribute to delayed patient reporting of NS symptoms.
  
  
  METHODS
  A constructivist grounded theory study used observations of chemotherapy consultations (13 h) and 31 in-depth interviews to explore beliefs, experiences, and behaviors related to NS. Participants included women with breast cancer, their carers (partners, family, or friends), and clinicians. An explanation for patient delays was developed through theoretical sampling of participants to explore emerging areas of interest and through constant comparison of data and their coding. This entailed iterative and concurrent data collection and analysis. Data were collected until saturation.
  
  
  RESULTS
  All patients who developed NS-type symptoms delayed presenting to hospital (2.5 h-8 days), sometimes repeatedly. Moderators of delay included metastatic disease, bereavement, fatalism, religious beliefs, and quality of relationships with clinicians. There was an interplay of behaviors between clinicians, patients, and carers where they subconsciously conspired to underplay the seriousness and possibility of NS occurring.
  
  
  CONCLUSIONS
  Findings have implications for health risk communication and development of holistic service models.
authors.affiliation: Guys and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK.|Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Oakley
authors.affiliation: Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.
authors.forename: Cath
authors.initials: C
authors.lastname: Taylor
authors.affiliation: Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Ream
authors.affiliation: Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Metcalfe
mesh_terms: D000328:Adult; D001293:Attitude to Death; D001943:Breast Neoplasms / Q000523:psychology*; D017028:Caregivers; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D003142:Communication; D003643:Death; D005260:Female; D033062:Friends; D066296:Grounded Theory; D006801:Humans; D008875:Middle Aged; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D012017:Referral and Consultation; D018805:Sepsis / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology
keywords: cancer chemotherapy; neutropenic sepsis; oncology; relational care; risk communication