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Research article
Barriers and Facilitators to Colorectal Cancer Diagnosis in New Zealand: A Qualitative Study
Tania Blackmore
University of Waikato Faculty of Arts and Social Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9411-0440
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Family Practice.
Background: New Zealand (NZ) has high rates of colorectal cancer but low rates of early diagnosis. Due to a lack of understanding of the pre-diagnostic experience from the patient’s perspective, it is necessary to investigate potential patient and health system factors that contribute to longer diagnostic intervals. Previous qualitative studies have discussed delays using The Model of Pathways to Treatment, but this has not been explored in the NZ context. This study aimed to understand the patient experience and perception of their general practitioner (GP) through the diagnostic process in the Waikato region of NZ. In particular, we sought to investigate potential barriers and facilitators that contribute to longer diagnostic intervals.
Methods: Ethical approval for this study was granted by the New Zealand Health and Disability Ethics Committee. Twenty-eight participants, diagnosed with colorectal cancer, were interviewed about their experience. Semi-structured interviews were audio recorded, transcribed verbatim and analysed thematically using The Model of Pathways to Treatment framework (intervals: appraisal, help-seeking, diagnostic).
Results: Participant appraisal of symptoms was a barrier to prompt diagnosis, particularly if symptoms were normalised, intermittent, or isolated in occurrence. Successful self-management techniques also resulted in delayed help-seeking. However if symptoms worsened, disruption to work and daily routines were important facilitators to seeking a GP consultation. Participants positively appraised GPs if they showed good technical competence and were proactive in investigating symptoms. Negative GP appraisals were associated with a lack of physical examinations and misdiagnosis, and left participants feeling dehumanised during the diagnostic process. However high levels of GP interpersonal competence could override poor technical competence, resulting in an overall positive experience, even if the cancer was diagnosed at an advanced stage. Māori participants often appraised symptoms inclusive of their sociocultural environment and considered the impact of their symptoms in relation to family.
Conclusions: The findings of this study highlight the importance of tailored colorectal cancer symptom communication in health campaigns, and indicate the significance of the interpersonal competence aspect of GP-patient interactions. These findings suggest that interpersonal competence be overtly displayed in all GP interactions to ensure a higher likelihood of a positive experience for the patient.
Keywords
colorectal cancer, delays, patient-physician relationship
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Additional file 1. Supplementary material. COREQ Checklist. Completed COREQ checklist
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Additional file 2. Supplementary material. Interview guide. Interview guide used.
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On 16 Sep, 2020
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On 15 Sep, 2020
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On 15 Sep, 2020
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Editorial decision: Major revision
On 02 Sep, 2020
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Received 01 Aug, 2020
Reviewer #2 agreed
On 30 Jul, 2020
Review #1 received
Received 30 Jul, 2020
Reviewer #1 agreed
On 23 Jul, 2020
Reviewers invited
Invitations sent on 22 Jul, 2020
Editor assigned
On 17 Jun, 2020
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On 04 Jun, 2020
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On 04 Jun, 2020
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On 15 May, 2020
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This preprint is under consideration at BMC Family Practice. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Barriers and Facilitators to Colorectal Cancer Diagnosis in New Zealand: A Qualitative Study
Tania Blackmore
University of Waikato Faculty of Arts and Social Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9411-0440
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 3
Posted 25 Sep, 2020
No comments provided
Editor assigned
On 16 Sep, 2020
Submission checks complete
On 15 Sep, 2020
Editor invited
On 15 Sep, 2020
No comments provided
Editorial decision: Major revision
On 02 Sep, 2020
Review #2 received
Received 01 Aug, 2020
Reviewer #2 agreed
On 30 Jul, 2020
Review #1 received
Received 30 Jul, 2020
Reviewer #1 agreed
On 23 Jul, 2020
Reviewers invited
Invitations sent on 22 Jul, 2020
Editor assigned
On 17 Jun, 2020
Submission checks complete
On 04 Jun, 2020
Editor invited
On 04 Jun, 2020
First submitted
On 15 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
General Practice
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Family Practice.
Background: New Zealand (NZ) has high rates of colorectal cancer but low rates of early diagnosis. Due to a lack of understanding of the pre-diagnostic experience from the patient’s perspective, it is necessary to investigate potential patient and health system factors that contribute to longer diagnostic intervals. Previous qualitative studies have discussed delays using The Model of Pathways to Treatment, but this has not been explored in the NZ context. This study aimed to understand the patient experience and perception of their general practitioner (GP) through the diagnostic process in the Waikato region of NZ. In particular, we sought to investigate potential barriers and facilitators that contribute to longer diagnostic intervals.
Methods: Ethical approval for this study was granted by the New Zealand Health and Disability Ethics Committee. Twenty-eight participants, diagnosed with colorectal cancer, were interviewed about their experience. Semi-structured interviews were audio recorded, transcribed verbatim and analysed thematically using The Model of Pathways to Treatment framework (intervals: appraisal, help-seeking, diagnostic).
Results: Participant appraisal of symptoms was a barrier to prompt diagnosis, particularly if symptoms were normalised, intermittent, or isolated in occurrence. Successful self-management techniques also resulted in delayed help-seeking. However if symptoms worsened, disruption to work and daily routines were important facilitators to seeking a GP consultation. Participants positively appraised GPs if they showed good technical competence and were proactive in investigating symptoms. Negative GP appraisals were associated with a lack of physical examinations and misdiagnosis, and left participants feeling dehumanised during the diagnostic process. However high levels of GP interpersonal competence could override poor technical competence, resulting in an overall positive experience, even if the cancer was diagnosed at an advanced stage. Māori participants often appraised symptoms inclusive of their sociocultural environment and considered the impact of their symptoms in relation to family.
Conclusions: The findings of this study highlight the importance of tailored colorectal cancer symptom communication in health campaigns, and indicate the significance of the interpersonal competence aspect of GP-patient interactions. These findings suggest that interpersonal competence be overtly displayed in all GP interactions to ensure a higher likelihood of a positive experience for the patient.
Figure 1