Background
Methods
Participants
Procedure
Analysis
Results
Characteristics | Participants |
---|---|
Recruitment source | ICBP Welsh database (n = 20; 26 % response rate calculated as a proportion of those eligible for the study after verbal contact was made) Snowball sampling (n = 8) ‘Communities First’ Partners (n = 2) |
Gender | Female (n = 17) Male (n = 13) |
Age | 50–60 years (n = 10) 61–70 years (n = 13) 71–80 years (n = 5) 81–90 years (n = 2) |
Symptom experience | Previous diagnosis of cancer (n = 5) Reported cancer symptoms (n = 16) No cancer symptom experience (n = 9) |
Educational attainment | Finished school before age 15 (n = 15) No qualifications or left school at age 16 (n = 15) |
Main source of household income | Wages or salary (n = 3) Pension (n = 18) Benefits (n = 8) Other (n = 1) |
Home ownership | Owns home (n = 6)a Privately rented housing (n = 11) Housing association or sheltered housing (n = 7) Council owned property (n = 6) |
Car ownership | Owns car (n = 9) Does not own car (n = 21) |
Capability
Cancer knowledge
“The thing is how do you know when you’ve got [cancer] anyway? You know what I mean? You don’t know really, until it reacts with you, know what I mean?” (Male, age 80, cough symptom reported, did not seek medical help)
“[Cancer is] in everything we eat…using different fertilisers to make [food] grow to keep the flies and that away…You read all this in the paper, eat this, eat that, it’s healthy for you, but it’s the sales patter to sell it I’m sure, because it’s not doing anyone any good…I say “eat what you like, eat it, if you like it eat it”…[cancer is] in what we eat, but you’ve got to eat, it’s as simple as that.” (Male, age 72, change in bladder habit reported, did not seek medical help)
“I never even heard of that there’s something wrong with your prostate, I didn’t even know what the prostate was…I was thinking about going to the toilet all the time?” (Male, age 75, previous diagnosis of cancer, sought help after 6 months)
Communication with Healthcare Professionals
“[The doctors] say to you “what do you think?” and as I say to them, “I’m not the doctor how do I know?” If it comes to diagnosing yourself why bother going to them? You know, what’s the point?” (Female, age 66, cough and reflux symptoms reported, did not seek medical help)
“I’m the type of person, I question something, [my husband] will accept it more than I will, he’ll say “oh well I’ve been told, listen now they’ve told me and that’s the end of it” [I say] “no it’s not the end of it, you disagree with it or you don’t believe it, question it again.” (Female, age 57, no symptoms reported, would seek medical help quickly for cancer symptom)
“You can write down what you want to discuss with the doctor while you are waiting…because sometimes if you don’t write them down, and you go there you forget.” (Female, age 71, no symptoms reported, would seek medical help quickly for lump and bleeding symptoms)
Motivation
Fearful and fatalistic beliefs about cancer
“It took me a long time to go [to the doctor] I know that, I was terrified…I was terrified of the answers…what I don’t know I can’t worry about can I?” (Female, age 88, previous diagnosis of cancer, sought medical help after a few months- unable to recall exact time)
“All I know is that once you get it, that’s your lot, as far as I know there is no cure …it’s a dirty disease isn’t it? That’s the description of cancer, it’s a dirty disease…you start thinking the worst and to be honest with you the worst is cancer! No one thinks of heart attacks, or fits, or strokes, the first thing is cancer. Phone the funeral director I’ve got cancer!” (Male, age 80, cough symptom reported, did not seek medical help)
“[People are] afraid I think it is to find out the truth. They know there’s something wrong, they’re just afraid to actually hear the doctor come out and say the word “cancer”…They’re afraid to go to the doctor’s in case they actually say “yes, you have got cancer” and a lot of people are afraid to hear that word you know…so a lot of them will just sort of put it off until they’re so ill they’ve got to go.” (Female, age 52, no symptoms reported, would seek medical help quickly if appraised as cancer)
Beliefs about treatments and early diagnosis
“It all depends on what cancer it is, if it was breast cancer I think you’ve got a good chance, if you got it early enough, bowel cancer is a good cancer if you’ve got to have cancer.” (Female, age 69, various gastric symptoms reported, sought medical help after 1 month)
“My sister she had radio, whatever you call it....on her throat and that when she had the throat cancer and when we went to see her, she was burned inside and outside, and it makes them ill and sick and whatever. Well a lot of people with cancer would rather die from the cancer than go through the treatment.” (Female, age 52, no symptoms reported, would seek medical help quickly if appraised as cancer)
Opportunity
Facilitators to a short patient interval
“I can talk to [my wife] better than if I go to the doctor and then [my wife] could take me down to the doctor…she’d do the talking and all this and that cos I clams up, I’m not a very good talker, she’s a better talker than me.” (Male, age 67, cough symptom reported, did not seek medical help)
“If it was me and I had any symptoms like that I would go straight and I wouldn’t hesitate in going to my GP. As I say I’ve got a good GP here.” (Female, age 60, no symptoms reported, would seek medical help immediately for a lump symptom)
Barriers to symptom presentation
“They don’t pay you to go to the doctor, you’ve got to clock in and clock out. I said "no, I can’t afford to lose time off work” and I don’t drive for another thing, so I said “where it would take 10 min to get down to you, I’ve got to wait for a bus, get down on the bus, and then go back to work which would take me an hour.” (Female, age 57, lump symptom reported, sought medical help after 2 months)
“The last three times I’ve been now I’ve seen three different doctors…I suppose if I was prepared to wait, I could see the same one” (Male, age 81, previous diagnosis of cancer, diagnosed incidentally through secondary care)
“I went in there with a complaint and he’s seven minutes. I said I got something else and he said “you’ve already come for the one complaint, you’ll have to make another appointment to see me again”.” (Male, age 80, cough symptom reported, did not seek medical help)
Experience of cancer
“It’s a waste of time, you’ll never cure [cancer], I’ve had seventeen in the family die of it.” (Male, age 56, no symptoms reported, would not seek medical help for symptoms)
“[My father] died in agony. I was there and he was, I’ll never forget it on [date] I watched him die in agony, like I watched my wife [die from cancer], through incompetence you know…” (Male, age 72, change in bladder habit reported, sought medical help within 1 month)
Lay advice in healthcare
“Well the first person I’d talk about [a symptom] to is my mate because she’s had a couple of scares and fortunately thank God she hasn’t got cancer and then the next person I would go and see is my doctor.” (Female, age 70, unexplained weight loss, sought medical help after 2 months)
“[My friend] had been complaining that she wasn’t well before Christmas but she’s so stubborn that she wouldn’t go to the doctors and we kept on saying to her “go, it’s not normal to lose this amount of weight in such a short time”, and she said “oh I’ll go now” and she did go now mind.” (Female, age 57, lump symptom reported, sought medical help after 2 months)
Social environment
“They’re on about we’ve got cures for this, cures for that, I think it’s just a big money making thing to be honest, I think that it’s a case of they got it and we ain’t sharing it because there’s too much money going in....” (Male, age 56, no symptoms reported, would not seek medical help for cancer symptoms)
“I get angry because they cut everybody else’s money back except the politicians and they get money and some of these have got three and four houses, cars, I’m thinking alright, why do you need all those houses?” (Female, age 52, no symptoms reported, would seek medical help quickly if appraised symptom as cancer)
“Your health goes because myself right, I need £10 for the gas and I’ve got £20 in my purse to last me the week, but it’s gonna cost me £15 to get fresh veg, meat and fruit. Then I would leave the fruit aside and the veg, to make sure that I’ve got my gas to keep warm.” (Female, age 57, no symptoms reported, would seek medical help quickly for symptoms)