Use this URL to cite or link to this record in EThOS:
Title: Factors affecting time taken by patients to present oral squamous cell cancer symptoms to health care professionals
Author: Bell, J. R.
ISNI:       0000 0000 6654 6920
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2017
Availability of Full Text:
Access from EThOS:
Access from Institution:
Patient delays in presenting oral squamous cell cancer (OSCC) symptoms to health care providers (HCPs) increases mortality and morbidity. The main aim of the thesis is to gain an understanding of decision-making processes that lead to presentation delay of potential OSCC symptoms. Chapter 1 of the thesis presents an introduction to the research. It is separated in to three sections. The first section provides a background in to (OSCC) and highlights the importance of reducing patient presentation delay in the disease. The second section explains the various theoretical approaches that are relevant to patient delay, while the third section provides examples of studies that have devised interventions based on the theoretical approaches described in the previous section. Chapter 2 of the thesis presents a systematic literature review of studies that have analysed reasons for patient delay in head and neck cancer. The review examines quantitative and qualitative studies separately using textual narrative synthesis. The main reasons for patient delay that are consistent across the studies are a lack of knowledge of head and neck cancer, interpreting symptoms as minor conditions that do not require medical attention and failing to attribute symptoms to cancer. Chapter 3 is the first of the empirical chapters. Previous research provides little information on timescales between patients noticing symptoms and consulting HCPS, or little information about events between these. This chapter is a descriptive study of the length of time that a consecutive sample of 38 patients took from noticing symptoms of OSCC to appraise those decisions, decide to consult a HCP and to do so. It also assesses the number and timings of re-interpretations and revisiting of decisions that patients made if they initially decided not to see a HCP. A new finding was that 17 patients were not referred on their first visit to a HCP, and that some required multiple visits before referral to a consultant. Chapter 4 uses the same sample to gain an understanding of appraisal and decision-making processes that lead to presentation delay of potential OSCC symptoms. Patients took part in semi-structured interviews. In a novel innovation, techniques derived from the cognitive interview protocol were used to enhance recall of appraisals and decisions leading to presentation and non-presentation (Wagstaff, Wheatcroft, Caddick, Kirby & Lamont, 2010). These techniques have not been applied in patient delay research before. New findings include a 'sort it' response to symptoms, where patients quickly presented to a HCP to resolve uncertainty about symptoms, and a 'don't want to think about it' response where patients delayed presentation because they attempted to minimise distress by avoiding thoughts about cancer or deliberately misattributing symptoms to minor causes. Chapter 5 highlights some of the limitations of using retrospective methods. A potentially better methodology that combines a retrospective method with a scenario based 'real time' method is described which was applied to the current research. A sample of community volunteers without oral OSCC engaged in a think-aloud task. Each volunteer was closely matched to a patient from the previous study based on risk factors of OSCC. The volunteers were given a scenario based on their matched patient's symptoms. Volunteers were prompted to interpret the information and to indicate how they would respond in the given situation. Interestingly, the majority of the volunteers responded in similar ways to the 'sort it' patients. This chapter suggests reasons for this finding.
Supervisor: Brown, Stephen ; Shaw, Richard ; Salmon, Peter Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral