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There is limited literature on the help-seeking behaviour of the Australian population in regards to lower bowel symptoms. In a South Australian study, in a consecutive sample of patients diagnosed with CRC, Young et al. (1) explored reasons for delayed diagnosis and for the delay in seeking medical advice for lower bowel symptoms. They reported that men were more likely to experience ‘patient-related delay’ in cancer diagnosis than women. The reasons cited by the participants in this study for delayed presentation to a GP were the attribution of symptoms to conditions such as haemorrhoids, belief that the symptoms would clear up spontaneously, and a desire to wait to seek advice until the symptoms exacerbated. Two participants were reluctant to undergo investigations advised by their GP after their initial visit (1).

In their survey on the help-seeking behaviour of an adult Australian population (n=1332) in regards to the potential symptoms of CRC, Cockburn et al. (2) found that less than 50% of the population was aware of all of the symptoms that could be indicative of CRC. The majority of the population knew only rectal bleeding as a symptom indicative of cancer. Nearly one in three Australian adults who had experienced lower bowel symptoms delayed seeking

medical advice for more than three months or did not seek advice at all. The primary reasons for delayed help seeking were similar to those reported by Young et al. (1) such as the attribution of rectal bleeding to haemorrhoids, and the perception that the symptoms did not warrant medical consultation. Some people did not want their family to worry about their symptoms, and others believed that a GP would not be able to help with their symptoms. Nearly 2% of the study population was reticent to seek help, believing that the tests would be embarrassing and/or unpleasant (2). Women were more likely to be aware of the symptoms of CRC than men, although they were not more likely to seek advice than men. Knowledge levels were directly related to people’s education levels and their beliefs about the benefits of the early detection of cancer. Cockburn et al. (2) suggested that media campaigns aiming to improve people’s knowledge about the risks of cancer had not been very successful in influencing people to seek timely medical advice. In light of their findings, they advocated for the need for more intensive public education campaigns focused on addressing negative perceptions of cancer and people’s lack of knowledge of the risks of cancer associated with lower bowel symptoms (2).

In their observational study (n=1996) on the process of cancer diagnosis in Queensland, Lynch et al. (3) observed that the majority of patients diagnosed with CRC were symptomatic. However, patients who experienced symptoms such as change in bowel habit, abdominal pain and those who had private health insurance were less likely to delay seeking help for their symptoms. Likewise, older patients were more likely to seek timely help than younger patients. Delays in help seeking were reported in people presenting with symptoms such as rectal bleeding, unexplained weight loss, nausea/vomiting, tiredness, increased flatulence and loss of appetite in their first consultation with a GP. In another Australian study, Eslick et al. (4) observed that nearly one in three people experiencing rectal bleeding had sought medical advice, although they found no gender differences in healthcare seeking. A 2012 Australian population-based study by Courtney et al. (5) found that nearly one in five Australians had never consulted a GP for rectal bleeding or for change in bowel habit. Courtney et al. (5) also reported that people who had ever been advised by a health

professional for screening were more likely to seek advice. The triggers for early (<2 weeks of symptom onset) help seeking for rectal bleeding were mainly the belief that the symptoms were serious, and the opportunity to discuss the symptoms while visiting a GP for other

health issues. People who had private health insurance were nearly four times more likely to seek early advice than those without private health insurance (5). In regards to change in bowel habit, people with lower household incomes, those within a healthy BMI range (18.0– 24.9) and those who had discussed their family history of CRC with a GP in any of their previous visits were more likely to seek medical advice. Likewise, those who had been informed of the risk of CRC by a GP in a previous visit and those who had persistent symptoms were likely to seek advice early (<4 weeks). Based on their findings, Courtney et al. emphasised the need to improve people’s knowledge of the potential risks associated with persistent lower bowel symptoms and the benefits of timely help seeking. However, findings from past studies cast doubt on the role of improving people’s knowledge of symptoms and encouraging them to seek help at an opportune time. Currently, there is mixed evidence on the translation of increased knowledge of CRC symptoms into timely help seeking for the early diagnosis of cancer. Some studies have found a positive association between

knowledge of symptoms and help seeking (6), and a negative association between knowledge and negative perceptions of cancer, implying that improving knowledge of the symptoms or disease may influence help seeking (7). However, a few other studies have found no

association between knowledge and help seeking (2, 8, 9).

The similar findings in these studies suggest that there has not been any major change in the help-seeking behaviour of Australians regards lower bowel symptoms over the past 12 years.