Help-seeking experiences of men diagnosed with colorectal cancer: A qualitative study

Oberoi DV, Jiwa M, McManus A, et al.

May 2016

European Journal of Cancer Care 2016; 25: 27-37

Most reported one or more symptoms prior to diagnosis including diarrhoea, rectal bleeding, abdominal pain and unintentional weight loss; two men had no symptoms. The nature and severity of symptoms (e.g. intermittent bleeding or bowel habit changes versus major episode of bleeding or bleeding with pain) lengthened or shortened the delay in seeking care. Men often ignored the symptoms when they first appeared but were prompted to seek care when they persisted, worsened, or new symptoms appeared.

Participants often attributed their symptoms to benign ailments such as haemorrhoids or poor eating habits. Some purchased over-the-counter products for these conditions which relieved symptoms but increased diagnosis delay. A few men believed their symptoms were due to work-related issues (e.g. lifting heavy weight), previous medical treatment, or side-effects of medications.

Most men discussed their symptoms and whether they warranted a GP consult with their partner and some discussed it with their mother, friend at work, or cousin. Participants typically initiated these conversations after the symptoms had persisted for several weeks or months. The majority were encouraged to seek care. Those who did not discuss their symptoms did so due to not having a partner, wishing to maintain privacy, and living alone.

The fear of having cancer prompted men with a family history of CRC to seek care while one man (without a family history) stated that this fear prevented him from seeking care.

Participants reported several delays after deciding to seek medical care. These included social and professional commitments and the belief that symptoms may not actually warrant medical help or that they may still clear up spontaneously. Two participants mentioned that previous poor experiences with the healthcare system further delayed their seeking care.

Most participants reported their GPs as performing a digital rectal examination and referring them on for a colonoscopy based on their age, symptoms and/or family history. However, five participants reported their GP as advising them not to worry about their symptoms.

Even when urgent referrals were made, some men reported long waiting times to see a surgeon in the public health system. One man with private health insurance had a colonoscopy within 2 days of referral whereas the remaining men waited 1 week to 6 months for this procedure.

Colorectal cancer (CRC) is a common cancer with a high mortality rate, particularly among men. This study considered the potential reasons for delay in the period of time between onset of symptoms and diagnosis of CRC for Australian men.

Twenty men with a recent diagnosis of CRC were interviewed about their experiences of lower abdominal symptoms and associated care received prior to CRC diagnosis. A theoretical model that largely considers patient-related factors (as opposed to healthcare-related factors) was used to guide data collection and analysis.

Diagnosis delay was explained by men’s inability to attribute symptoms to a condition that warranted medical care and also to procrastination in seeking such care once it was believed to be necessary. Misdiagnosis by GPs and long waiting times for colonoscopy further compounded the delay experienced by men.

The theoretical model used focused primarily on patient-related delay which is likely to have presented a skewed picture of men’s experiences of diagnosis delay. Further, the model fails to take into account the non-linear process of men’s help-seeking experience for CRC.

This study did not consider potential delay between colonoscopy and first treatment, an important time period for satisfactory CRC patient outcomes.