Patient Related Diagnostic Delay, Symptom Appraisal and Lay Consultation in Head and Neck Cancer

Abstract

The objectives of this thesis were to; 1) identify established risk factors and gaps in the current peer reviewed literature relating to factors associated with patient related diagnostic delay in head and neck cancer, 2) describe and document patients’ personal responses to symptoms of head and neck cancer, the characteristics of the patients’ lay-consultants and the responses that the patients received from their lay-consultants and 3) assess the association between patient/network-related diagnostic delay and a) whether the patient felt any urgency to investigate their symptoms, b) whether the patient told someone in their social network about their symptoms (lay-consultancy) and c) lay-consultant influence. The first manuscript is a scoping review that demonstrates that there is a lack of studies that address; the personal symptom experiences of patients, the psycho-social processes of help-seeking and the independent effects of suspected risk factors for head and neck cancer. The results of the first manuscript also provided me with guidance on what the important confounders of our primary relationship of interest were most likely to be. The second manuscript suggests that patient related delay may be influenced by the patients’ mistaken belief that their symptoms were non-urgent with or without the influence of their lay-consultant. The third manuscript provides evidence that the primary barrier to seeking help from an HCP is whether or not those individuals experiencing symptoms think they are urgent enough to warrant further investigation. The study found no evidence to support the assertion that increased risk of delay is associated with decreased lay-consultancy. The results of this thesis indicate that most of the patient related delay occurs during the individuals’ symptom appraisal process with or without input from their social network. I think that individuals at risk of late stage presentation of head and neck cancer should be provided with targeted information encouraging them to seek help from a health care provider if the key signs or symptoms of head and neck cancer have not resolved within three weeks.