The Prolonged Diagnostic Pathway of Young Adults (Aged 25–39) with Cancer in the United Kingdom: Results from the Young Adult Cancer Patient Journey Study

Purpose: Teenagers and young adults (TYAs; aged 13–24) experience prolonged intervals to cancer diagnosis. Insight into diagnostic intervals in young adults (YAs; aged 25–39) and subgroups at risk for long intervals is lacking. We investigated the diagnostic pathway of YA cancer patients, examined patient and tumor characteristics associated with its length, and compared the patient interval length of our sample with a TYA cohort. Methods: In this cross-sectional survey YAs diagnosed with cancer in the UK in the past five years completed a questionnaire describing their patient (time from first symptom to first doctor consultation) and healthcare interval (from first consultation until consultation with a cancer specialist), sociodemographic, and clinical characteristics. Associations between characteristics and interval length were examined and compared with previously published data in TYAs. Results: Among 341 YAs the patient interval lasted ≥2 weeks, ≥1 month, and ≥3 months in 60%, 42%, and 21%, respectively, compared to 48%, 27%, and 12% in the TYA group. The healthcare interval lasted ≥2 weeks, ≥1 month, and ≥3 months in 62%, 40%, and 17% of YA patients, respectively. YAs with melanoma or cervical cancer were most likely to experience long intervals, whereas YAs with breast cancer and leukemia were most likely to experience short intervals. Conclusions: Most YAs were not seen by a cancer specialist within 2 weeks of GP consultation. Interval lengths in YAs were associated with cancer diagnosis. Patient intervals were longer among YAs than among TYAs. Our study highlights long diagnostic pathways among YAs and calls for more awareness among healthcare professionals about malignancies in this age group.

The Doctor Turned into an Instrument

I have been working as a cancer specialist since 1984, and I have witnessed an explosion of therapeutic possibilities. In caring for my fellow human beings, I have learned to recognize the effectiveness and the extent of my treatments, but also their limits, which are closely connected to the reality of the human condition that is so rich but naturally limited. As he strives for the physical, psychological, social, and spiritual well-being of the sick person who seeks his help, the doctor stands at the patient’s side to combat pain and suffering with determination, perseverance, humility, and patience.

Ascertaining patients’ understandings of their condition: a conversation analysis of contradictory norms in cancer specialist consultations

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Patient-centred care requires patients to be active participants in decision-making in consultations. Decision-making participation requires patients to understand their condition and to be able to convey their health literacy to medical specialists they encounter. Based on conversation analysis of 18 audio-recorded consultations between cancer patients and a range of cancer care specialists, this article analyses the ways cancer specialists attempt to ascertain their patient’s understanding of their disease. Cancer specialists routinely enquire about their patient’s understanding. In doing so, they phrase enquiries in different ways, resulting in different patient responses. How questions are phrased can require patients to deal with contradictory norms in the consultation, such as the patient being competent but not assuming medical expertise, and potentially hinder patient participation. Alternatively, questions can allow patients to draw on their own experience and so facilitate greater patient involvement. Questions aimed directly at the patient’s medical understanding result in minimal or negative responses. In contrast, questions directed at what the patient has been told or has experienced, elicit longer and more in-depth responses from the patient. This analysis illuminates the co-construction of cancer specialist consultations and suggests simple ways in which patient involvement in the consultation can be facilitated.

Ascertaining patients’ understandings of their condition: a conversation analysis of contradictory norms in cancer specialist consultations

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Patient-centred care requires patients to be active participants in decision-making in consultations. Decision-making participation requires patients to understand their condition and to be able to convey their health literacy to medical specialists they encounter. Based on conversation analysis of 18 audio-recorded consultations between cancer patients and a range of cancer care specialists, this article analyses the ways cancer specialists attempt to ascertain their patient’s understanding of their disease. Cancer specialists routinely enquire about their patient’s understanding. In doing so, they phrase enquiries in different ways, resulting in different patient responses. How questions are phrased can require patients to deal with contradictory norms in the consultation, such as the patient being competent but not assuming medical expertise, and potentially hinder patient participation. Alternatively, questions can allow patients to draw on their own experience and so facilitate greater patient involvement. Questions aimed directly at the patient’s medical understanding result in minimal or negative responses. In contrast, questions directed at what the patient has been told or has experienced, elicit longer and more in-depth responses from the patient. This analysis illuminates the co-construction of cancer specialist consultations and suggests simple ways in which patient involvement in the consultation can be facilitated.