RT Journal Article
SR Electronic
T1 Factors influencing symptom appraisal and help-seeking of older adults with possible cancer: a mixed-methods systematic review
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e702
OP e712
DO 10.3399/BJGP.2021.0655
VO 72
IS 723
A1 Daniel Jones
A1 Erica Di Martino
A1 Stephen H Bradley
A1 Blessing Essang
A1 Scott Hemphill
A1 Judy M Wright
A1 Cristina Renzi
A1 Claire Surr
A1 Andrew Clegg
A1 Richard Neal
YR 2022
UL http://bjgp.org/content/72/723/e702.abstract
AB Background The cancer burden falls predominantly on older (≥65 years) adults. Prompt presentation to primary care with cancer symptoms could result in earlier diagnosis. However, patient symptom appraisal and help-seeking decisions involving cancer symptoms are complex and may be further complicated in older adults.Aim To explore the effect of older age on patients’ appraisal of possible cancer symptoms and their decision to seek help for these symptoms.Design and setting Mixed-methods systematic review.Method MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Library, Web of Science Core Collection, ASSIA, the ISRCTN registry, and the National Institute for Health and Care Excellence were searched for studies on symptom appraisal and help-seeking decisions for cancer symptoms by adults aged ≥65 years. Studies were analysed using thematic synthesis and according to the Synthesis Without Meta-Analysis guidelines.Results Eighty studies were included with a total of 32 995 participants. Studies suggested a possible association between increasing age and prolonged symptom appraisal interval. Reduced knowledge of cancer symptoms and differences in symptom interpretation may contribute to this prolonged interval. In contrast, in the current study a possible association was found between increasing age and prompt help-seeking. Themes affecting help-seeking in older adults included the influence of family and carers, competing priorities, fear, embarrassment, fatalism, comorbidities, a desire to avoid doctors, a perceived need to not waste doctors’ time, and patient self-management of symptoms.Conclusion This review suggests that increasing age is associated with delayed cancer symptom appraisal. When symptoms are recognised as potentially serious, increasing age was associated with prompt help-seeking although other factors could prolong this. Policymakers, charities, and GPs should aim to ensure older adults are able to recognise potential symptoms of cancer and seek help promptly.