Barriers and Facilitators to Colorectal Cancer Diagnosis in New Zealand: A Qualitative Study

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aut.relation.articlenumber206en_NZ
aut.relation.journalBMC Family Practiceen_NZ
aut.relation.volume21en_NZ
aut.researcherDrabsch, Julie
dc.contributor.authorBlackmore, Ten_NZ
dc.contributor.authorNorman, Ken_NZ
dc.contributor.authorKidd, Jen_NZ
dc.contributor.authorCassim, Sen_NZ
dc.contributor.authorChepulis, Len_NZ
dc.contributor.authorKeenan, Ren_NZ
dc.contributor.authorFirth, Men_NZ
dc.contributor.authorJackson, Cen_NZ
dc.contributor.authorStokes, Ten_NZ
dc.contributor.authorWeller, Den_NZ
dc.contributor.authorEmery, Jen_NZ
dc.contributor.authorLawrenson, Ren_NZ
dc.date.accessioned2021-04-28T02:02:54Z
dc.date.available2021-04-28T02:02:54Z
dc.date.copyright2020en_NZ
dc.date.issued2020en_NZ
dc.description.abstractBACKGROUND: New Zealand (NZ) has high rates of colorectal cancer but low rates of early diagnosis. Due to a lack of understanding of the pre-diagnostic experience from the patient's perspective, it is necessary to investigate potential patient and health system factors that contribute to longer diagnostic intervals. Previous qualitative studies have discussed delays using The Model of Pathways to Treatment, but this has not been explored in the NZ context. This study aimed to understand the patient experience and perception of their general practitioner (GP) through the diagnostic process in the Waikato region of NZ. In particular, we sought to investigate potential barriers and facilitators that contribute to longer diagnostic intervals. METHODS: Ethical approval for this study was granted by the New Zealand Health and Disability Ethics Committee. Twenty-eight participants, diagnosed with colorectal cancer, were interviewed about their experience. Semi-structured interviews were audio recorded, transcribed verbatim and analysed thematically using The Model of Pathways to Treatment framework (intervals: appraisal, help-seeking, diagnostic). RESULTS: Participant appraisal of symptoms was a barrier to prompt diagnosis, particularly if symptoms were normalised, intermittent, or isolated in occurrence. Successful self-management techniques also resulted in delayed help-seeking. However if symptoms worsened, disruption to work and daily routines were important facilitators to seeking a GP consultation. Participants positively appraised GPs if they showed good technical competence and were proactive in investigating symptoms. Negative GP appraisals were associated with a lack of physical examinations and misdiagnosis, and left participants feeling dehumanised during the diagnostic process. However high levels of GP interpersonal competence could override poor technical competence, resulting in an overall positive experience, even if the cancer was diagnosed at an advanced stage. Māori participants often appraised symptoms inclusive of their sociocultural environment and considered the impact of their symptoms in relation to family. CONCLUSIONS: The findings of this study highlight the importance of tailored colorectal cancer symptom communication in health campaigns, and indicate the significance of the interpersonal competence aspect of GP-patient interactions. These findings suggest that interpersonal competence be overtly displayed in all GP interactions to ensure a higher likelihood of a positive experience for the patient.en_NZ
dc.identifier.citationBMC Family Practice 21, 206 (2020). https://doi.org/10.1186/s12875-020-01276-w
dc.identifier.doi10.1186/s12875-020-01276-wen_NZ
dc.identifier.issn1471-2296en_NZ
dc.identifier.issn1471-2296en_NZ
dc.identifier.urihttps://hdl.handle.net/10292/14145
dc.languageengen_NZ
dc.publisherBioMed Centralen_NZ
dc.relation.urihttps://bmcfampract.biomedcentral.com/articles/10.1186/s12875-020-01276-w
dc.rights© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
dc.rights.accessrightsOpenAccessen_NZ
dc.subjectColorectal canceren_NZ
dc.subjectDelaysen_NZ
dc.subjectPatient-physician relationshipen_NZ
dc.titleBarriers and Facilitators to Colorectal Cancer Diagnosis in New Zealand: A Qualitative Studyen_NZ
dc.typeJournal Article
pubs.elements-id392845
pubs.organisational-data/AUT
pubs.organisational-data/AUT/Faculty of Health & Environmental Science
pubs.organisational-data/AUT/Faculty of Health & Environmental Science/School of Clinical Sciences
pubs.organisational-data/AUT/Faculty of Health & Environmental Science/School of Clinical Sciences/Nursing Department
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