Symptom appraisal and help-seeking for complications of cancer and its treatment: a systematic review and qualitative synthesis

Abstract

Background: complications of cancer and its treatment can be life-threatening, disrupt cancer treatment and negatively impact health-related quality of life. While we understand how people appraise symptoms prior to a cancer diagnosis, little is known about how people decide to seek help for complications during cancer treatment.

Aim: characterise how patients and informal caregivers appraise symptoms suggestive of, and decide whether to seek help from urgent and emergency care (or not) for, complications of cancer and its treatment.

Methods: systematic review and qualitative synthesis. Six electronic databases (ASSIA, CINAHL, Embase, MEDLINE, PsycInfo and Web of Science) were searched for papers using qualitative methods published since 2000 (last search performed on 11 October 2024). Supplementary and cluster searches were performed. 7120 records were identified and 22 papers (representing accounts of over 300 people with cancer) were included following the application of the ‘appraisal prompts’ criteria. Data were synthesised using abductive analysis.

Findings: a conceptual map was developed to articulate how five analytic constructs interact and influence the ‘patient work’ of detecting, interpreting and responding to complications. Findings show that appraising symptoms is iterative and informed by knowledge, skills and perceptions developed prior to treatment through experiences of complications, and following contact with urgent and emergency care.

Conclusion: this is the first review to characterise how patients and informal caregivers make decisions about cancer-related complications. Findings show preparation for complications should be treated as a process (rather than an event), and poor experiences of services contribute to delayed help-seeking and risk avoidable harm.

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Identifiers

ORCID for Richard Wagland: orcid.org/0000-0003-1825-7587

ORCID for Joanne Turnbull: orcid.org/0000-0002-5006-4438

ORCID for Alison Richardson: orcid.org/0000-0003-3127-5755

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