Over-reassurance and undersupport after a 'false alarm': a systematic review of the impact on subsequent cancer symptom attribution and help seeking

Published on Feb 1, 2015in BMJ Open2.692
· DOI :10.1136/BMJOPEN-2014-007002
Cristina Renzi14
Estimated H-index: 14
(UCL: University College London),
Katriina L. Whitaker22
Estimated H-index: 22
(UCL: University College London),
Jane Wardle159
Estimated H-index: 159
(UCL: University College London)
Sources
Abstract
Objectives This literature review examined research into the impact of a previous ‘all-clear’ or non-cancer diagnosis following symptomatic presentation (‘false alarm’) on symptom attribution and delays in help seeking for subsequent possible cancer symptoms. Design and setting The comprehensive literature review included original research based on quantitative, qualitative and mixed data collection methods. We used a combination of search strategies, including in-depth searches of electronic databases (PubMed, EMBASE, PsychInfo), searching key authors and articles listed as ‘related’ in PubMed, and reference lists. We performed a narrative synthesis of key themes shared across studies. Participants The review included studies published after 1990 and before February 2014 reporting information on adult patients having experienced a false alarm following symptomatic presentation. We excluded false alarms in the context of screening. Primary and secondary outcome measures We evaluated the effect of a ‘false alarm’ on symptom attribution and help seeking for new or recurrent possible cancer symptoms. Results Overall, 1442 papers were screened and 121 retrieved for full-text evaluation. Among them, 19 reported on false alarms and subsequent symptom attribution or help seeking. They used qualitative (n=14), quantitative (n=3) and mixed methods (n=2). Breast (n=7), gynaecological (n=3), colorectal (n=2), testicular (n=2), and head and neck cancers (n=2) were the most studied. Two broad themes emerged underlying delays in help seeking: (1) over-reassurance from the previous ‘all-clear’ diagnosis leading to subsequent symptoms being interpreted as benign, and (2) unsupportive healthcare experiences in which symptoms were dismissed, leaving patients concerned about appearing hypochondriacal or uncertain about the appropriate next actions. The evidence suggested that the effect of a false alarm can persist for months and even years. Conclusions In conclusion, over-reassurance and undersupport of patients after a false alarm can undermine help seeking in the case of new or recurrent potential cancer symptoms, highlighting the need for appropriate patient information when investigations rule out cancer.
Figures & Tables
Download
📖 Papers frequently viewed together
200579.32The Lancet
References68
Newest
#1C. R. Hitchins (Worthing Hospital)H-Index: 5
#2A. Lawn (Worthing Hospital)H-Index: 1
Last. M. R. McFall (Worthing Hospital)H-Index: 5
view all 4 authors...
Aim The NHS Cancer Plan describes initiatives to improve patient care in the UK, including the two-week rule cancer referral pathway. To meet this target a straight to test (STT) endoscopy service was devised to expedite diagnosis of suspected colorectal cancer. Our novel study aimed to determine patient satisfaction with this new approach to rapid access investigation. Method An anonymized questionnaire was posted to 300 patients who had undergone STT endoscopy in our unit between January and J...
Source
#1Cecillia Högberg (Umeå University)H-Index: 1
#2Pontus Karling (Umeå University)H-Index: 22
Last. Thomas Ljung (Mid Sweden University)H-Index: 8
view all 5 authors...
Objective. To evaluate the value, risks, and shortcomings of immunochemical faecal occult blood tests (iFOBTs) in the diagnosis of colorectal cancer (CRC) and adenomas with high-grade dysplasia (HG ...
Source
#1Mark Petticrew (Lond: University of London)H-Index: 101
#2Eva Rehfuess (LMU: Ludwig Maximilian University of Munich)H-Index: 40
Last. Amanda Sowden (Ebor: University of York)H-Index: 59
view all 8 authors...
Abstract Objectives Although there is increasing interest in the evaluation of complex interventions, there is little guidance on how evidence from complex interventions may be reviewed and synthesized, and the relevance of the plethora of evidence synthesis methods to complexity is unclear. This article aims to explore how different meta-analytical approaches can be used to examine aspects of complexity; describe the contribution of various narrative, tabular, and graphical approaches to synthe...
Source
While colonoscopy is the gold standard for the evaluation of the colon, research on post-colonoscopy colorectal cancers has increased our awareness of its limitations. In this issue of the Journal, Erichsen et al. provide evidence to suggest that post-colonoscopy colorectal cancers are most likely due to missed cancers at the time of the index colonoscopy, rather than due to aggressive tumor biology. Ultimately, studies demonstrating the shortcomings of colonoscopy are a call to action for the g...
Source
#1Mary Bond (University of Exeter)H-Index: 14
#2Toby G. Pavey (University of Exeter)H-Index: 24
Last. Chris Hyde (University of Exeter)H-Index: 67
view all 7 authors...
Objectives To identify the psychological effects of falsepositive screening mammograms in the UK. Methods Systematic review of all controlled studies and qualitative studies of women with a false-positive screening mammogram. The control group participants had normal mammograms. All psychological outcomes including returning for routine screening were permitted. All studies had a narrative synthesis. Results The searches returned seven includable studies (7/4423). Heterogeneity was such that met...
Source
#1Mary Bond (University of Exeter)H-Index: 14
#2Toby G. PaveyH-Index: 24
Last. Chris Hyde (University of Southampton)H-Index: 67
view all 7 authors...
addresses: Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK.
Source
#1P G Vaughan-Shaw (Cheltenham General Hospital)H-Index: 9
#2J Cutting (Cheltenham General Hospital)H-Index: 2
Last. J. M. D. Wheeler (Cheltenham General Hospital)H-Index: 6
view all 4 authors...
Aim The inappropriate use of the ‘2-week wait’ pathway for suspected colorectal cancer (CRC2ww) may overload urgent clinics and delay the assessment and investigation of other patients. Those who have been previously referred and investigated for suspected colorectal cancer may present one group that does not warrant repeat urgent referral. This paper aims to identify the incidence and diagnostic yield of repeat CRC2ww referrals. Method All CRC2ww patients referred to our unit over a 4-year peri...
Source
#1R. Tarling (UCLan: University of Central Lancashire)H-Index: 1
#2A. Gale (Lancashire Teaching Hospitals NHS Foundation Trust)H-Index: 1
Last. P. Dey (UCLan: University of Central Lancashire)H-Index: 1
view all 6 authors...
Women with postmenopausal bleeding (PMB) are referred for specialist assessment within 2 weeks of presentation to their GP. No research has previously examined women's experiences of expedited referral. This was investigated in the present study using questionnaires (6-item State Anxiety Inventory (6-STAI)) and focus groups. A total of 55 women completed questionnaires. Results showed high levels of anxiety at first hospital visit (mean 47.0 (SD 14.27); 95% CI 43.14–50.93). Scores declined by 90...
Source
#1Lindsay Forbes ('KCL': King's College London)H-Index: 23
#2Alice E. Simon (UCL: University College London)H-Index: 23
Last. Jane Wardle (UCL: University College London)H-Index: 159
view all 16 authors...
Background: There are wide international differences in 1-year cancer survival. The UK and Denmark perform poorly compared with other high-income countries with similar health care systems: Australia, Canada and Sweden have good cancer survival rates, Norway intermediate survival rates. The objective of this study was to examine the pattern of differences in cancer awareness and beliefs across these countries to identify where these might contribute to the pattern of survival. Methods: We carrie...
Source
#1Suzanne E. Scott ('KCL': King's College London)H-Index: 23
#2Fiona M Walter (University of Cambridge)H-Index: 52
Last. Jon Emery (University of Cambridge)H-Index: 54
view all 5 authors...
Background. Studying and understanding pathways to diagnosis and treatment is vital for the development of successful interventions to encourage early detection, presentation, and diagnosis. An existing framework posited to describe the decisional and behavioural processes that occur prior to treatment (Andersen et al.’s General Model of Total Patient Delay) does not appear to match the complex and dynamic nature ofthepathwaysintoandthroughthehealthcaresystemorprovideaclearframeworkfor research....
Source
Cited By36
Newest
#1Sara Benitez Majano (Lond: University of London)H-Index: 4
#2Georgios Lyratzopoulos (UCL: University College London)H-Index: 51
Last. Cristina Renzi (UCL: University College London)H-Index: 14
view all 5 authors...
Background null Cancer patients often have pre-existing comorbidities, which can influence timeliness of cancer diagnosis. We examined symptoms, investigations and emergency presentation (EP) risk among colorectal cancer (CRC) patients by comorbidity status. null Methods null Using linked cancer registration, primary care and hospital records of 4836 CRC patients (2011-2015), and multivariate quantile and logistic regression, we examined variations in specialist investigations, diagnostic interv...
Source
Background: The reassurance provided during patient-therapist interactions is significantly associated with psychosocial outcomes, including fear and increased confidence. Currently, there are no available reviews that discuss the impact of reassurance for patients with musculoskeletal (MSK) pain. The aim of the present review was to qualitatively synthesize themes around reassurance mechanisms, and the impact during the interaction between patients with MSK pain and therapists. A systematic sea...
Source
#1Richard D Neal (University of Exeter)H-Index: 1
#2Lesley Smith (University of Leeds)H-Index: 7
Urgent GP cancer referrals, often referred to as 2-week wait (2WW) referrals in England (with equivalent processes in the devolved nations), have changed the landscape of cancer diagnosis in the UK. The data presented by Round et al ,1 demonstrate this starkly: referrals have increased hugely over the past decade and the detection rate (DR; the percentage of new cancer cases treated resulting from a 2WW referral) has increased from 41% to 52% over this period. This is especially good news as pat...
Source
#1Rebecca Kim (CRCs: Cooperative Research Centre)
#2Catherine M. McMahon (CRCs: Cooperative Research Centre)H-Index: 32
OBJECTIVE To describe and analyse the linguistic structure of audiological diagnoses for infants, to determine ways to optimise the delivery of diagnostic information to parents during this typically emotive time. DESIGN This study analysed the linguistic structure of audio-recorded infant diagnostic appointments. STUDY SAMPLE Nine appointments conducted by four experienced paediatric audiologists were analysed. RESULTS Diagnoses of normal hearing were delivered explicitly and in a straightforwa...
Source
#1Abdullah Alsoghier (KSU: King Saud University)H-Index: 2
#2Richeal Ni Riordain (UCC: University College Cork)H-Index: 11
Last. Stephen Porter (UCL Eastman Dental Institute)H-Index: 73
view all 4 authors...
BACKGROUND The psychosocial impact of receiving the diagnosis of oral epithelial dysplasia, which presents up to 3.5% increased annual risk of mouth cancer, remain unknown. Using validated instruments, the present study aimed to investigate the prevalence and existing correlations between anxiety, depression and dental anxiety symptoms and burden on oral health-related quality of life. METHODS A clinical cohort of 82 patients with oral dysplasia was asked to complete the Hospital Anxiety and Dep...
Source
#1Maryam Momeni (IUMS: Iran University of Medical Sciences)H-Index: 2
#2Forough Rafii (IUMS: Iran University of Medical Sciences)H-Index: 19
BACKGROUND: Cancer survival largely depends on its early diagnosis. Therefore, assessing help-seeking behaviours among people with potential symptoms of cancer is essential. AIM: This study aimed to analyse the concept of help-seeking behaviour for cancer symptoms. METHODS: This concept analysis was conducted using Rodger's evolutionary method. An online literature search was conducted in the PubMed, Scopus and Cochrane databases to find relevant articles published from 2000 to 2017 in English p...
Source
#1Suzanne E. Scott ('KCL': King's College London)H-Index: 23
#2Richard Oakley (Guy's and St Thomas' NHS Foundation Trust)H-Index: 13
Last. F. WarburtonH-Index: 1
view all 4 authors...
Abstract Objectives Very little is known about those who receive a negative (benign) result after referral for suspected cancer, including their risk for future cancer. This service evaluation aimed to track the occurrence of cancer (of any type) in the 5 years after an appointment for suspected head and neck cancer (HNC) and compare to those referred to hospital for routine ear nose and throat reasons. Materials & methods Patient identifiers of referrals to one hospital Trust with either a) sus...
Source
#4Elliott Lever (UCL: University College London)H-Index: 3
#5David D'Cruz (Guy's Hospital)H-Index: 11
Objective The aim was to explore the impact of patient-physician interactions, pre- and post-diagnosis, on lupus and UCTD patients' psychological well-being, cognition and health-care-seeking behaviour. Methods Participants were purposively sampled from the 233 responses to a survey on patient experiences of medical support. Twenty-one semi-structured interviews were conducted and themes generated using thematic analysis. Results The study identified six principal themes: (i) the impact of the d...
Source
#1Catherine E. Grimley (Coventry University)H-Index: 1
#2Pamela M. KatoH-Index: 1
Last. Elizabeth A. Grunfeld (Birkbeck, University of London)H-Index: 36
view all 3 authors...
Purpose: The aim of this systematic review was to identify health or health belief factors associated with mammography attendance or with self-initiated medical help-seeking for breast cancer symptoms among women in Europe. Methods: Five databases were searched for articles published between 2005 and 2018. Meta-analyses were conducted for 13 factors related to screening attendance and two factors associated with help-seeking behaviour. Where there were too few studies to include in the meta-anal...
Source
#1Sonja Kummer (UCL: University College London)H-Index: 3
#2Jo Waller (UCL: University College London)H-Index: 62
Last. Samantha L Quaife (UCL: University College London)H-Index: 12
view all 6 authors...
BACKGROUND: Research on the psychological impact of low-dose computed tomography (LDCT) lung cancer screening has typically been narrow in scope and restricted to the trial setting. OBJECTIVE: To explore the range of psychological and behavioural responses to LDCT screening offered as part of a Lung Heath Check (LHC), including lung cancer risk assessment, spirometry testing, a carbon monoxide reading and smoking cessation advice. METHODS: Semi-structured interviews were carried out with 28 curr...
Source
This website uses cookies.
We use cookies to improve your online experience. By continuing to use our website we assume you agree to the placement of these cookies.
To learn more, you can find in our Privacy Policy.