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In order to understand people’s help-seeking behaviours during COVID-19 and inequalities in accessing care, semi-structured interviews were carried out with people who contacted primary care with possible symptoms of colorectal cancer. The Candidacy Framework was used to understand how people decided to seek medical help, how they navigated services, their ease of accessing services, and their perception of the interaction with healthcare professionals. Disparities between higher and lower socioeconomic status participants were found in how people appraised their symptoms during the pandemic, and how they perceived changes in primary care in terms of considerations around the need to visit the GP during the pandemic, understanding how to access primary care, views about remote technology, safety netting during COVID-19, and attitudes towards accessing care. Recommendations are made for minimising negative impacts on patient care during and post-pandemic. - Box 1.
Summary of differences in responses to possible colorectal cancer symptoms during COVID-19 according to the Candidacy Framework25
Theme (in bold) and subtheme Lower SES Higher SES How people decided to seek medical help through appraisal of symptoms Distinguishing between colorectal and COVID-19 symptoms Uncertainty in attributing colorectal symptoms to COVID-19 Certainty in differentiating NHS-cited COVID-19 symptoms from colorectal symptoms Relationship between body vigilance and lifestyle modifications Less body-vigilant Heightened body vigilance and ability to connect symptoms to underlying problems How people navigated services Accessing health care in the face of a pandemic Less assertive/confident in accessing primary care compared with others Described reasons why they were eligible to access primary care Understanding the process and perceptions of safety measures when accessing primary care Uncertainty about process and hesitation attending primary care Realistic expectations of accessing primary care and fewer safety concerns attending primary care Impact of COVID-19 on how patients interacted with healthcare professionals Views about utility of remote technology Reservations about using remote technology Positive attitudes towards adoption of remote technology Knowing how and when to seek further help Reported less active care planning and safety netting Reported knowing about care planning and safety-netting strategies used SES = socioeconomic status.
Provide accurate and up-to-date information about symptoms of COVID-19 in healthcare settings and on relevant websites.
Build on campaigns designed to promote symptom awareness and importance of earlier cancer diagnosis, to specifically target sociodemographic groups less likely to recognise symptoms of colorectal cancer or less likely to be vigilant about changes in their bodies.
Provide better signposting to services and pathways to access these by utilising known, effective ways to communicate new bookings and consulting methods with patients, as well as keeping GP surgery websites and their phone/text communication up to date.
Ensure infection control measures for COVID (and wider) are overt and embedded into NHS services.
Provide people with active safety netting, including a timeframe for follow-up or symptoms to look out for and ensure that follow-up options (for example, patient-activated call, GP app access) are offered to all patients, who are provided with help to use it or alternative options if needed.
Support and build on training for primary care to address health inequalities, particularly around access and digital exclusion.
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