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

2020 ◽  
Author(s):  
Tania Blackmore ◽  
Kimberley Norman ◽  
Jacquie Kidd ◽  
Shemana Cassim ◽  
Lynne Chepulis ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
New Zealand ◽  
Help Seeking ◽  
Barriers And Facilitators ◽  
Diagnostic Process ◽  
Interpersonal Competence ◽  
Technical Competence ◽  
Positive Experience ◽  
The Impact ◽  
Diagnostic Intervals

Abstract Background: 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.

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

2020 ◽  
Author(s):  
Tania Blackmore ◽  
Kimberley Norman ◽  
Jacquie Kidd ◽  
Shemana Cassim ◽  
Lynne Chepulis ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
New Zealand ◽  
Help Seeking ◽  
Barriers And Facilitators ◽  
Diagnostic Process ◽  
Interpersonal Competence ◽  
Technical Competence ◽  
Positive Experience ◽  
The Impact ◽  
Diagnostic Intervals

Abstract Background: 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.

scholarly journals Barriers and facilitators to colorectal cancer diagnosis in New Zealand: a qualitative study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Tania Blackmore ◽  
Kimberley Norman ◽  
Jacquie Kidd ◽  
Shemana Cassim ◽  
Lynne Chepulis ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
New Zealand ◽  
Help Seeking ◽  
Barriers And Facilitators ◽  
Diagnostic Process ◽  
Interpersonal Competence ◽  
Technical Competence ◽  
Positive Experience ◽  
The Impact ◽  
Diagnostic Intervals

Abstract Background 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.

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

2020 ◽  
Author(s):  
Tania Blackmore ◽  
Kimberley Norman ◽  
Jacquie Kidd ◽  
Shemana Cassim ◽  
Lynne Chepulis ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
New Zealand ◽  
Help Seeking ◽  
Barriers And Facilitators ◽  
Diagnostic Process ◽  
Interpersonal Competence ◽  
Technical Competence ◽  
Positive Experience ◽  
The Impact ◽  
Diagnostic Intervals

Abstract Background 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.

scholarly journals Routes to Diagnosis for Suspected Sarcoma: The Impact of Symptoms and Clinical Findings on the Diagnostic Process

Sarcoma ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-12 ◽  
Author(s):  
Heidi Buvarp Dyrop ◽  
Peter Vedsted ◽  
Mathias Rædkjær ◽  
Akmal Safwat ◽  
Johnny Keller
Keyword(s):  
Primary Care ◽  
Clinical Findings ◽  
Diagnostic Process ◽  
Time Intervals ◽  
Local Hospital ◽  
Doctor Visit ◽  
Presenting Symptoms ◽  
One Year ◽  
The Impact ◽  
Diagnostic Intervals

Background and Objectives. Sarcoma patients often experience delay before diagnosis. We examined the association between presenting symptoms/signs and time intervals for suspected sarcoma patients.Methods. 545 consecutive patients suspected for sarcoma referred over a one-year period were included. Median time intervals in routes to diagnosis were collected from medical records and questionnaires.Results. 102 patients (18.7%) had a sarcoma; 68 (12.5%) had other malignancies. Median interval for the patient (time from first symptom to first doctor visit), primary care, local hospital, sarcoma center, diagnostic, and total interval for sarcoma patients were 77, 17, 29, 17, 65, and 176 days, respectively. Sarcoma patients visited more hospital departments and had longer median primary care (+10 days) and diagnostic intervals (+19 days) than patients with benign conditions. Median primary care (−19 days) and sarcoma center (−4 days) intervals were shorter for patients with a lump versus no lump. Median patient (+40 days), primary care (+12 days), diagnostic (+17 days), and total intervals (+78 days) were longer for patients presenting with pain versus no pain. GP suspicion of malignancy shortened local hospital (−20 days) and total intervals (−104 days).Conclusions. The main part of delay could be attributed to the patient and local hospitals. Length of time intervals was associated with presenting symptoms/signs and GP suspicion.

HealthPathways: creating a pathway for health systems reform

2015 ◽  
Vol 39 (1) ◽  
pp. 9 ◽  
Author(s):  
Suzanne Robinson ◽  
Richard Varhol ◽  
Colin Bell ◽  
Frances Quirk ◽  
Learne Durrington
Keyword(s):  
New Zealand ◽  
System Integration ◽  
Secondary Care ◽  
Waiting Times ◽  
Barriers And Facilitators ◽  
Care Services ◽  
Early Evidence ◽  
The Right ◽  
The Impact ◽  
Delivery Of Health Services

Inefficiencies in the co-ordination and integration of primary and secondary care services in Australia, have led to increases in waiting times, unnecessary presentations to emergency departments and issues around poor discharge of patients. HealthPathways is a program developed in Canterbury, New Zealand, that builds relationships between General Practitioners and Specialists and uses information technology so that efficiency is maximised and the right patient is given the right care at the right time. Healthpathways is being implemented by a number of Medicare Locals across Australia however, little is known about the impact HealthPathways may have in Australia. This article provides a short description of HealthPathways and considers what it may offer in the Australian context and some of the barriers and facilitators to implementation. What is known about the topic? Early evidence on HealthPathways suggests that the program does seem to be strengthening relationships between GPs and secondary care specialists. In New Zealand advances in efficiency and system integration have been noted. However, there is limited evidence on the effectiveness of HealthPathways in Australia. What does this paper add? It is one of the first published papers to provide a perspective around HealthPathways and draws existing evidence and research to explore some of the barriers and facilitators to the development and implementation of HealthPathways in Australia. What are the implications for practitioners’? Early evidence suggests HealthPathways could help GPs and other practitioners’ in the delivery of health services, it could also help to strengthen practitioner relationships.

Order out of chaos? Autism spectrum disorder coordinators’ impact on service delivery in New Zealand

2021 ◽  
pp. 103985622110092
Author(s):  
Matthew Eggleston ◽  
Katherine Eggleston ◽  
Hiran Thabrew ◽  
Shannon Hennig ◽  
Christopher Frampton
Keyword(s):  
Autism Spectrum Disorder ◽  
New Zealand ◽  
Support Groups ◽  
Parent Satisfaction ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Diagnostic Process ◽  
Care Plans ◽  
Key Aspects ◽  
The Impact

Objective: To evaluate the impact of autism spectrum disorder (ASD) coordinators (ASDCs) on key aspects of the experience of obtaining an ASD diagnosis and post-diagnostic supports in New Zealand. Method: Members of New Zealand ASD parent support groups were surveyed. Results: Of 516 parents, 41.3% had seen an ASDC. The majority were satisfied. Parents who saw ASDCs pre-diagnosis were more likely to be satisfied with the diagnostic process ( p = .04) and saw fewer professionals before receiving a diagnosis ( p = .04). Parents who had seen ASDCs post-diagnosis were more likely to be satisfied with post-diagnostic supports ( p < .001) and their coordination ( p < .001). Conclusions: ASDCs are well regarded by parents and improve key aspects of the process of obtaining an ASD diagnosis and post-diagnostic supports. Given the particularly low rates of parent satisfaction with post-diagnostic supports (23%) and their coordination (19%), ASDCs may be of most value when employed post-diagnosis to assist parents in navigating key supports and co-developing comprehensive individualised care plans.

scholarly journals Why does New Zealand have such poor outcomes from colorectal cancer?: the importance of the pre-diagnostic period

2021 ◽  
Vol 13 (1) ◽  
pp. 15
Author(s):  
Melissa Firth ◽  
Tania Blackmore ◽  
Lynne Chepulis ◽  
Rawiri Keenan ◽  
Tim Stokes ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
New Zealand ◽  
Help Seeking ◽  
Screening Programme ◽  
Public Awareness ◽  
Critical Role ◽  
Target Population ◽  
Inhibitory Factors ◽  
Pubmed Database ◽  
Poor Outcomes

ABSTRACT INTRODUCTIONOver 3000 cases of colorectal cancer (CRC) are diagnosed annually in New Zealand. The proportion of late stage diagnoses is higher than in similar countries, and highest in Māori and Pacific patients. Survival outcomes are poorer than for people in Australia and poor for Māori and Pacific peoples. A regional screening programme is not yet available to the entire target population (60–74 years). AIMThis study reviews research investigating the pre-diagnostic pathway for CRC in New Zealand and how this may contribute to poorer outcomes. METHODSThis was a scoping review of original articles examining the pre-diagnostic period for CRC published on the PubMed database between 2009 and 2019. Findings were interpreted within the Model of Pathways to Treatment framework and in context of international evidence. RESULTSIn total, 83 publications were assessed; eight studies were included. Studies were mainly older than 5 years, qualitative, and focused on screening. Facilitatory factors for the appraisal and help-seeking intervals increased CRC public awareness and the critical role of general practitioners. No specific facilitatory or inhibitory factors were identified for the diagnostic interval, but two studies found that time frames did not meet national and international targets. One study discovered longer pre-diagnostic intervals were associated with younger age at diagnosis. DISCUSSIONLimited recent research has investigated the CRC pre-diagnostic pathways in NZ. Identification of facilitatory and inhibitory factors and implementation of appropriate strategies to improve them alongside the wider uptake of the screening programme may improve stage at diagnosis and outcomes for New Zealand CRC patients.

scholarly journals Differences in the breast cancer diagnostic process across stage groups in Ontario, Canada

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Patti Groome ◽  
Marlo Whitehead ◽  
Li Jiang ◽  
Julie Gilbert ◽  
Eva Grunfeld ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Imaging ◽  
Screening Program ◽  
Stage Iv ◽  
Stage I ◽  
Diagnostic Process ◽  
Cancer Diagnostic ◽  
Diagnostic Interval ◽  
The Impact ◽  
Diagnostic Intervals

ABSTRACT ObjectivesEarly diagnosis leads to better cancer survival and short diagnostic intervals reduce patient anxiety. We are studying factors that prolong the breast cancer diagnostic process in Ontario, Canada. ApproachThis is a retrospective study of all patients diagnosed 2007-2011 (n=33,752). We linked data from Cancer Care Ontario and the Institute for Clinical Evaluative Sciences including: Ontario Cancer Registry, physician claims, ambulatory, ER visits, and hospital discharges. Detection method (screening versus symptomatic) was determined using Screening Program and claims data. The diagnostic interval is the time from first relevant health care encounter to the definitive diagnosis. Elements of the diagnostic interval include: use of imaging, biopsy, and the number of encounters and providers. ResultsOverall, 30.6% were screen-diagnosed and the median diagnostic interval was 40 days (IQR 21-80). The median interval was shorter in the screened group at 32 days versus symptomatic at 45 days. The diagnostic interval was longer for stage I patients at 47 days compared to stage II (37 days), stage III (33 days) or stage IV (22 days). Stage IV patients were less likely to be diagnosed via biopsy (44% vs 61%) and the symptomatic stage IV subgroup less likely to have breast imaging (61% vs 96%). 26% of stage IV patients saw 0 or 1 providers while 8% of stage I patients saw 6 or more. 19% of stage I patients had 10 or more encounters overall versus 15% and 28% had >1 mammogram versus 14%. Effects are largely similar in screened and symptomatic groups. ConclusionShorter diagnostic intervals in stage IV are associated with a more direct diagnostic path. We will present results quantifying the number of days attributable to the diagnostic elements. Understanding the impact of elements of the diagnostic process provide targets for improvement of its length.

Application of the Health Belief Model to Help-Seeking Behaviors of Working Men With Hearing Impairment Living in Deprivation in New Zealand

2017 ◽  
Vol 2 (7) ◽  
pp. 39-47
Author(s):  
Phillip Luey ◽  
Kim Wise
Keyword(s):  
New Zealand ◽  
Health Belief Model ◽  
Hearing Impairment ◽  
Help Seeking ◽  
Relative Deprivation ◽  
Health Belief ◽  
Structured Interviews ◽  
Belief Model ◽  
The Impact ◽  
The Health Belief Model

There is a growing area of research investigating the relationship between hearing impairment and deprivation; However, this has not been investigated in New Zealand. This study used the Health Belief Model as a framework to investigate if men of high relative deprivation had barriers to seeking hearing services. Twelve participants were recruited and semi-structured interviews were conducted using the Hearing Beliefs Questionnaire. Overall, participants thought they were susceptible to hearing impairment and the impact of hearing impairment could be severe. All participants identified barriers to help-seeking for hearing services and amplification. Most participants believed that amplification would be beneficial, but only under certain conditions.

The Impact of Universal Suicide-Prevention Programs on the Help-Seeking Attitudes and Behaviors of Youths

Crisis ◽  
2013 ◽  
Vol 34 (2) ◽  
pp. 82-97 ◽  
Author(s):  
Bonnie Klimes-Dougan ◽  
David A. Klingbeil ◽  
Sarah J. Meller
Keyword(s):  
Suicide Prevention ◽  
Help Seeking ◽  
Prevention Programs ◽  
Universal Prevention ◽  
Help Seeking Attitudes ◽  
Attitudes And Behaviors ◽  
Seeking Behavior ◽  
And Behaviors ◽  
Suicide Prevention Programs ◽  
The Impact

Background: While the ultimate goal of adolescent suicide-prevention efforts is to decrease the incidence of death by suicide, a critical intermediary goal is directing youths toward effective sources of assistance. Aim: To comprehensively review the universal prevention literature and examine the effects of universal prevention programs on student’s attitudes and behaviors related to help-seeking. Method: We systematically reviewed studies that assessed help-seeking outcomes including prevention efforts utilizing (1) psychoeducational curricula, (2) gatekeeper training, and (3) public service messaging directed at youths. Of the studies reviewed, 17 studies evaluated the help-seeking outcomes. These studies were identified through a range of sources (e.g., searching online databases, examining references of published articles on suicide prevention). Results: The results of this review suggest that suicide-prevention programming has a limited impact on help-seeking behavior. Although there was some evidence that suicide-prevention programs had a positive impact on students’ help-seeking attitudes and behaviors, there was also evidence of no effects or iatrogenic effects. Sex and risk status were moderators of program effects on students help-seeking. Conclusions: Caution is warranted when considering which suicidal prevention interventions best optimize the intended goals. The impact on adolescents’ help-seeking behavior is a key concern for educators and mental-health professionals.

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