These data show that colorectal participants had longer mean patient intervals than lung participants, which concurs with the work of Lyratzopoulos et al (2015) on patient intervals. This may be because people tolerate and consider bowel symptoms for longer than they would respiratory symptoms.
There did not appear to be any association between time to presentation and age, employment status, or deprivation within this sample. This finding is in line with other research which also found no association between these characteristics and time to presentation (Macleod et al. 2009). There was little evidence of an association between the length of the patient interval and sex, which also concurs with previous research (Macleod et al. 2009).
Participants with no educational qualifications had longer mean patient intervals, compared to those educated to GCSE level or above. An association between education and time to presentation has previously been shown for colorectal cancer patients (Macleod et al. 2009) and the same appears to be true for lung participants in this sample also.
0 20 40 60 80 100 1 2 3 4 M e an In te rv al Len gth (d ay s)
'Other Avoidance' Subscale Score
Mean Interval Length and 'Other
Avoidance' Score
Lung Participants Colorectal Participants All Participants
98 Cohabitation was associated with shorter patient intervals for colorectal participants and all participants combined. Lung participants who lived alone actually had shorter mean patient intervals than lung participants who cohabited. The finding for colorectal, and ‘all’, participants would fit with the hypothesis that co-habiting increases social contact and support, leading to shorter patient intervals. However, the lung data contradicts both this hypothesis, and other research which has shown that living alone is strongly associated with patient delay for lung cancer patients (Smith et al. 2009).
The type of symptom people experience could be associated with time to presentation. Bleeding was associated with short patient intervals for both colorectal and lung participants in this study, however, other studies have found rectal bleeding and unexplained bleeding to be associated with longer help-seeking intervals (Pedersen et al. 2013), and lower levels of help-seeking (Whitaker et al. 2016), respectively. Pain was only associated with shorter intervals for lung participants and it may be that people respond differently to experiences of pain in the chest or back (lung participants) than they do to experiences of pain in the abdomen or rectum (colorectal participants). It may be that pain in the stomach and rectum is more normalised, because pain in these areas is a more common occurrence, whereas pain in the chest and back is of greater alarm for individuals as it is more unusual or ‘out of the blue’ for most people. An examination of symptom type and diagnostic intervals for lung cancer found that chest or shoulder pain was associated with a shorter total diagnostic interval, however, this work does not differentiate between the length of the patient interval in relation to the two locations of pain (Walter et al. 2015). Across all participants, ‘systemic’ symptoms were associated with shorter intervals than symptom site specific ‘general’ symptoms, which is an interesting finding.
Although my results are not statistically significant, the trend for shorter patient intervals amongst those who discussed their symptoms concurs with other studies which have found that symptom disclosure is associated with shorter patient intervals (Burgess et al. 1998; Pedersen et al. 2011). Among participants who discussed their symptom(s) with somebody else, a greater proportion had short patient intervals and a much smaller proportion had a long patient interval, when compared to participants who did not discuss their symptoms with anybody else. This correlates with the findings of Pedersen et al (2011), from their work on social support and time to presentation, who found that disclosure of symptoms significantly reduced the likelihood of women having ‘long patient delay’ (Pedersen et al. 2011).
99 No associations between the length of the patient interval and ‘partner support’, ‘partner avoidance’ or ‘other avoidance’ were found in this sample. However, there was a significant relationship between the length of the patient interval and ‘other support.’ Pedersen et al (2011), in their analysis of data using these subscales, found that increasing levels of partner and other support significantly reduced the likelihood of having ‘long patient delay’, whereas increasing levels of other avoidance significantly increased the risk of having ‘long patient delay’ among females. Although data from this study has not shown there to be a significant relationship between ‘partner support’ and time to presentation, there was a statistically significant relationship between ‘other support’ and time to presentation. Interestingly Pedersen et al (2011) found that for women the length of the patient interval was influenced by the levels of support from both partners and others, whereas for men, being in a relationship and partner support were the most important factors for reducing time to presentation. Therefore, we would have expected it to be more likely that we would see an association with ‘partner support’ and time to presentation than we would see an association between ‘other support’ and time to presentation. It may be that for participants within this sample the support of wider social networks was most influential on their time to presentation. Because of the small sample size for this data, it would not be viable to explore time to presentation, social support and sex together, as the numbers of participants within categories would be very small, with a number of categories containing no data.
The lack of statistical significance found in some analyses, and unexpected findings in others, is very probably the result of the small sample size of this study, particularly in analyses of social support score. If there were more participants, trends in the data would likely be clearer and any anomalous, or outlying, results would have less of an impact on the dataset overall. The results from this questionnaire analysis do provide some interesting departure points from which it would be of value to examine a larger sample, particularly the association between social support, symptom disclosure and symptom type on time to presentation.
4.5 Summary
The quantitative findings presented in this chapter have thrown up a number of interesting observations, particularly the fact that colorectal participants had longer patient intervals than lung participants and that blood and pain were associated with shorter patient intervals than general, or systemic, symptoms.
100 Qualitative research is often used to help explain the bare bones of quantitative data and it is to the qualitative aspects of this research that we will turn in the next two chapters. The second of these (Chapter Six) looks at patient’s narratives in their entirety: the first (Chapter Five) analyses the results of the interviews with a view to identifying certain patterns across and between the groups.
101
Chapter Five: Interview Findings
The findings from the qualitative interviews are broken down into three sections. The first section explores patient pathways to consultation, looking at experiences of symptom onset, appraisal and help-seeking decisions. The wider contextual factors which influenced how participants appraised and responded to their symptoms are then considered, focusing on four key areas; individual experience, interpersonal relationships, health care system interactions and social and temporal context. Finally, I compare the help-seeking journeys of patients who presented quickly, those who took slightly longer to present, and those who reported prolonged patient intervals, in order to consider factors salient to each of these groups of people.