Table 1 Table of included studies
Study | Method | Sample | Country | Tumour site | Socio-economic measure | Measures: Knowledge (K), Beliefs (B), Perceived barriers (PB), Perceived facilitators (PF), Symptomatic Presentation (SP) | Measure of association between variables of interest and socioeconomic indicator (qualitative studies not applicable) | Quality appraisal |
|---|---|---|---|---|---|---|---|---|
Brain et al. (2014) [28] | Hypothetical Quantitative | 1043 women. Aged 50 years and over | Wales | Ovarian | Postcode, education | K: Recognition (mean, 6.85 symptoms) B: Cancer worry PB: Emotional and practical barriers SP: Sought medical help in under 3 weeks (n = 898) | K: Lower education associated with lower knowledge (F(2, 1005) = 8.23, p < 0.001); higher deprivation (postcode) associated with lower knowledge (F3,886 = 2.82, p < 0.05) B: NR PB: NR SP: Higher education associated with longer time to SP, (OR = 2.64, p ≤ 0.001); NS difference between deprivation by postcode and anticipated delay (X2(3) = 6.73, p > 0.05) NS | Good |
Brouha et al. (2005) [76] | Retrospective Quantitative | 189 men and women. Mean age: 59 years | Holland | Oral and Pharyngeal | Education, income | K: Symptom interpretation (‘cancer’, n = 2), misattribution of symptoms to dental problems delayed SP PB: Symptom did not interfere with daily life PF: Persistence of symptom, development of new symptom SP: Mean time to symptom presentation (pharyngeal, 45 days; oral, 28 days) | K: NR PB: NR PF: NR SP: Education and income not associated with time to SP (statistics NR) | Medium |
Burgess et al. (1998) [45] | Retrospective Qualitative | 185 women. Mean age: 54 years | UK | Breast | Occupation | K: Symptom interpretation (46 % thought their symptom indicated cancer) B: Fear PF: Symptom disclosure, appearance of new symptoms, appointment booked with GP for another reason SP: Waited over 3 months to seek medical help (19 %) | Medium | |
Burgess et al. (2000) [67] | Retrospective Qualitative | 158 women. Mean age: 53 years | UK | Breast | Occupation | PB: Life events SP: Waited over 3 months to seek medical help (18 %) | Medium | |
Burgess et al. (2001) [43] | Retrospective Qualitative | 46 women. Mean age: 54.1 years | UK | Breast | Occupation | K: Symptom interpretation (‘lump’ most attributed to cancer) B: Consequences of treatment PB: Not wanting to bother the doctor, poor health service utilisation, competing life priorities PF: Symptom disclosure, change in symptom SP: Waited over 3 months to seek medical help (n = 31) | Medium | |
Cameron and Hinton (1968) [58] | Retrospective Quantitative | 83 women | UK | Breast | Education, husband’s occupation | K: Symptom interpretation B: Fear, worry SP: 61 % sought medical help within 1 month | K: NR B: NR SP: Higher education associated with shortest time to SP for lump symptoms (x2 = 6.6, p < 0.05); Higher social group (husband’s occupation) associated with shortest time to SP (x2 = 3.02, p < 0.01) | Poor |
Caplan (1995) [44] | Retrospective Quantitative | 162 women | US | Breast | Income, education, employment | PB: Fluctuating symptoms, relationship with GP SP: Waited over 2 months to seek medical help (n = 27) | PB: NR SP: Lower socioeconomic group (various indices) associated with longer time to SP, but NS: High vs low income (OR 2.56, 95 % CI: 0.68-8.64*); High vs low education (OR 1.07, 95 % CI: 0.41-2.77*); Working vs non-working (OR 0.72, 95 % CI: 0.27-1.99*) | Poor |
Carter-Harris et al. (2015) [69] | Retrospective Qualitative | 11 men (n = 4) and women (n = 7). Age range: 40-76 years | US | Lung | Education, employment | K: Symptom interpretations (one participant was alarmed at symptoms) PB: Vague and intermittent nature of symptoms PF: Worsening of symptoms, good relationship with GP SP: Immediate (n = 1) | Medium | |
Chonjnacka-Szawlowska et al. (2013) [36] | Retrospective Quantitative | 301 men (n = 186) and women (n = 115). Mean age: 42.3 years | Poland | All | Education | K: Recall, mean: 1.51 B: Fatalism and cancer curability SP: Mean time to symptom presentation: 6 months and 10 days; stage of cancer | K: NR B: NR SP: NS correlation between education and stage of cancer (statistics NR) | Medium |
Coates et al. (1992) [42] | Retrospective Quantitative | 735 women (410 black and 325 white). Age range: 20 to 79 | US | Breast | Education, occupation, poverty index (income/no of people in household) | K: Symptom interpretation B: Fatalism PB: Symptom disclosure, other comorbid conditions, appointment with doctor booked for another reason SP: Median time to symptom presentation (black women, 16 days; white women, 14 days) | K: NR B: NR PB: NR SP: Higher education associated with shorter time to SP (Mantel-cox 1.43, 95 % CI: 1.11-1.86, p < 0.05); Low deprivation (poverty index) associated with shorter time to SP (Mantel-Cox 1.24, 95 % CI: 1-1.54, p < 0.05) | Good |
Cockburn et al. (2003) [54] | Retrospective Quantitative | 1332 men (40 %) and women (60 %). Aged 40 years and over | Australia | Colorectal (Bowel) | Education | K: Recall (25 % could not recall any symptoms), symptom interpretation B: Benefits of early diagnosis SP: 306 had experienced a symptom, 31.9 % did not seek medical help | K: Higher education associated with higher K of symptoms (PR 0.93, 95 % CI: 0.89-0.96*) B: Higher education more likely to hold positive beliefs about the benefits of early diagnosis (statistics NR) SP: NR | Medium |
Esteva et al. (2013) [70] | Retrospective Quantitative | 795 men (n = 489) and women (n = 291) | Spain | Colorectal | Social class, education | K: Symptom interpretation (‘not serious’, 65.6 %) PF: Symptom disclosure, good relationship with GP (trust) SP: Median time to symptom presentation (19 days) | K: NR SP: NS association between social class and time to SP (statistics NR), NS association between education and time to SP (statistics NR) | Medium |
Facione and Facione (2006) [59] | Retrospective Qualitative | 28 women. Mean age: 42.34 years | US | Breast | Income, education, health insurance | K: Symptom interpretation B: Fear, fatalism, benefits of early diagnosis PB: Worry about losing relationship with partner if diagnosed with cancer PF: Symptom disclosure SP: Sought medical help after 3 months (n = 15) | Medium | |
Facione et al. (2002) [56] | Hypothetical Quantitative | 669 women. Mean age: 46.95 years | US | Breast | Income, education, health care insurance | K: Recognition (10 % recognised all or all but one symptoms) B: Fatalism PB: Difficulties with access, prejudice in health care, concerns about deportation, use of alternative therapies SP: Likely to delay (23.7 %). | K: Higher education associated with higher symptom recognition (F3,690 = 32.32, p < 0.001) B: NR PB: NR SP: Lack of insurance associated with longer time to SP (Cramer’s V = 0.187, p < 0.001); Lower education associated with longer time to SP (Cramer’s V = 0.288, p < 0.001); Lower income associated with longer time to SP (Cramer’s V = 0.291, p < 0.001) | Good |
Facione et al. (1997) [84] | Hypothetical Quantitative | 352 African American or Black women. Mean age: 38.6 years | US | Breast | Income, Education, Employment | B: Fear, fatalism PB: Poor health service utilization SP: 11.6 % = strong disposition to SP. | B: NR PB: NR SP: Stronger disposition to SP associated with lower education (r = 0.19, p < 0.01) and lower income (r = 0.32, p < 0.001) | Medium |
Facione and Dodd (1995) [83] | Retrospective Qualitative | 39 women. Mean age: 49.6 years | US | Breast | Income, education | K: Symptom interpretation B: Fear PB: Competing life priorities PF: Appearance of new symptom, worsening of symptoms, symptom disclosure SP: 59 % sought medical help within 1 week | Medium | |
Fitzpatrick et al. (1998) [57] | Hypothetical Quantitative | 280 men. Mean age: 53.7 years | Ireland | Prostate | Health insurance, occupation | B: Fear PB: Poor health service utilisation, dislike of doctors, embarrassment SP: 81 % would seek medical help if developed urinary symptoms | B: NR PB: NR SP: Non-manual social class associated with higher willingness to attend GP with symptoms (OR 1.8, p < 0.05**) | Good |
Forbes et al. (2011) [29] | Hypothetical Quantitative | 1515 women from various ethnic groups (White, South Asian, Black). Aged 30 years and over | UK | Breast | Postcode (IMD) | K: Recognition (18 % recognised 5 or more non-lump symptoms) PB: self-efficacy, worry what the doctor might find, embarrassment, worry about wasting doctors time, difficulty getting an appointment SP: 73 % would seek help within 1 week | K: Differences between ethnic groups for cancer awareness not due to IMD score or lower level of education (statistics NR) PB: Differences between ethnic groups for PB not due to IMD score (statistics NR) SP: NR | Good |
Forbes et al. (2014) [64] | Retrospective Quantitative | 1999 men (n = 1077) and women (n = 922). Aged 50 or over | UK | All | Postcode | K: Symptom interpretation PB: 48 % of patients reported at least one barrier SP: Delay over 3 months (n = 21 %) | B: NR PB: NR SP: Lowest socioeconomic group associated with longest time to SP (1.51, 95 % CI: 1.18-1.88*) | Good |
Freidman et al. (2006) [38] | Retrospective Quantitative | 124 women. Mean age: 44.3 years | US | Breast | Employment, education | B: Fear PB: Worry what the symptom might be, difficulty getting an appointment, cost, denial SP: Mean time to symptom presentation (9 months) | B: NR PB: NR SP: Lower education associated with longest time to SP (Fishers Exact test, p < 0.01**) | Medium |
Goldsen et al. (1957) [61] | Retrospective Quantitative | 727 men and women | US | All | Income, education and occupation | K: Symptom interpretation (20 % thought symptoms indicated cancer) B: Cancer worry, fatalism PB: Poor health service utilization, symptom not noticed PF: Symptom disclosure SP: 51.3 % sought medical help under 30 days | K: NR B: NR PB: NR PF: NR SP: Lower income, education and occupation associated with longest time to SP (statistics NR) | Medium |
Gould et al. (2010) [39] | Retrospective Qualitative | 14 women. Aged range: 30 to 69 years | Canada | Breast | Education, employment, income | K: Symptom interpretation (poor for non-lump symptoms) B: Fear PB: Previous benign disease, watchful waiting, competing life priorities PF: Symptom disclosure, already have another appointment booked. SP: All women waited 8+ weeks | Medium | |
Grant et al. (2010) [82] | Retrospective Qualitative | 15 men (n = 7) and women (n = 8). Aged 45 years and under | Scotland | Oral | Postcode | K: Symptom interpretation PB: Self-medication PF: Already had an appointment booked SP: Sought medical help within 8 weeks (n = 8) | Medium | |
Greer (1974) [68] | Retrospective Quantitative | 160 women with stage I or stage II cancer. Aged 70 years and under | UK | Breast | Social Class | K: Symptom interpretation B: Fear, fatalism PB: Embarrassment SP: 64 % sought medical help within 1 month | K: NR B: NR PB: NR SP: NS difference between time to SP and social class (statistics NR) | Poor |
Hunter et al. (2003) [30] | Hypothetical Quantitative | 546 women. Mean age: 47 years | UK | Breast | Occupation | K: Recognition (good, mean 6.65) B: Beliefs about treatment SP: 58.6 % would seek immediate medical help. | K: NR NR: NR SP: Socioeconomic group not associated with time to SP (F(1,518) = 0.29, p > 0.05) | Medium |
Kakagia et al. (2013) [34] | Retrospective Quantitative | 513 men (n = 56.5 %) and women (n = 43.5 %). Mean age: 67.5 years | Greece | Skin | Education, ethnicity, area of residence | K: Symptom interpretation B: Fear, fatalism PB: Other serious comorbidities, poor health service utilisation, dislike of doctors and hospitals, transport issues, worry about wasting doctors time, embarrassment, competing life demands PF: Symptom disclosure, active encouragement to seek medical help SP: Mean time to symptom presentation (3.9 months) | K: NR B: NR PB: NR PF: NR SP: Longer time to SP associated with lower socioeconomic group (OR 1.89, 95 % CI: 0.9-3.8. p < 0.001) and lower education (OR 3.01, 95 % CI: 1.6-5.6, p < 0.001) | Medium |
Lam et al. (2009) [63] | Retrospective Qualitative | 37 women. Age range 20-81 years | Hong Kong | Breast | Employment, education | K: Symptom interpretation B: fear, fatalism PB: Watchful waiting, poor general health service utilisation, cost, competing life priorities, embarrassment PF: Persistence of symptoms, appearance of new symptom, symptom disclosure, symptom interfering with daily life, appointment booked for another reason SP: Waited over 3 months to seek medical help (n = 14) | Medium | |
Li et al. (2012) [65] | Retrospective Quantitative | 425 women. Mean age: 51.97 years | Hong Kong | Breast | Employment, education | B: Fear PB: Cost, gender of doctor, unsure where to seek medical help, competing life priorities, no history of breast problems, symptom disclosure PF: Symptom disclosure SP: Median time to symptom presentation (14 days) | B: NR PB: Symptom disclosure for women with lower education less likely to translate into immediate SP (x2 = 6.4, d.f. = 2, p < 0.05) PF: NR SP: Longer time to SP associated with higher education (OR 3.35, 95 % CI:1.19-9.42, p < 0.05) and full time employment (OR 2.52, 95 % CI: 1.18-5.36, p < 0.05) | Good |
Loehrer et al. (1991) [71] | Retrospective Qualitative | 128 men (n = 33) and women (n = 95). Mean age: 63 years | US | All | Employment, income, education | B: Curability of cancer, cancer is contagious, surgery causes cancer to spread SP: Poor for non-specific symptoms | Medium | |
Low et al. (2013) [31] | Hypothetical Quantitative | 1000 women. Mean age: 47 years | UK | Ovarian | Education, car ownership, home ownership | K: Recall (poor, mean 0.6) and recognition (good, mean 6.3) PB: Mean number of barriers endorsed (2.2), emotional, practical and service barriers SP: Varied by symptom, most would seek help under 2 weeks | K: NR PB: NR SP: Higher socioeconomic group associated with longer time to SP (beta = 0.12, SE 0.05, p < 0.001**) | Good |
Magarey et al. (1977) [72] | Retrospective Quantitative | 64 women. Age in years: less than 40 (n = 13), 40-60 (n = 28), over 60 (n = 23). | Australia | Breast | Education | PB: Denial, anxiety SP: Most sought medical help within 2 weeks (n = 35) | PB: NR SP: Education not associated with time to SP (statistics NR) | Poor |
Marlow et al. (2014) [78] | Hypothetical Qualitative | 54 women from ethnic minority groups living with a comparison of white women. Age range: 25-64 years | UK | Breast and Ovarian | Employment, education, living arrangement | K: Recall (good for lumps/ bleeding, poor for other symptoms) B: Fear, fatalism, benefits of early diagnosis PB: Poor relationship with GP, emotional barriers, practical barriers, service barriers, competing life priorities PF: Symptom disclosure SP: Varied: days to months. All sought help within 3 months. | Medium | |
McCaffery et al. (2003) [50] | Hypothetical Quantitative | 1637 men (n = 763) and women (n = 874). Age range: 16-74 years | UK | Colorectal | Education | K: Recall (poor) B: Fear SP: 92.8 % would anticipate seeking medical help if noticed blood in stool for more than 2 weeks. | K: Higher education associated with higher symptom recall (x2 [4] = 73.98, p < 0.001) B: Lower education associated with most negative beliefs (x2 [4] = 74.96, p < 0.001) SP: NS association with education and SP intentions (statistics NR) | Good |
Meechan et al. (2003) [46] | Retrospective Mixed | 85 women. Mean age: 38.9 years | New Zealand | Breast | Education | PB: Having a family member with cancer, low emotional response to symptom PF: High emotional response to symptom SP: Median time to symptom presentation (14 days) | PB: NR PF: NR SP: NS association between education and time to SP (t (83) = -1.26, p > 0.05) | Medium |
Mor (1990) [74] | Retrospective Mixed | 700 patients. Age range: 45 to 90 years | US | Lung, Breast and Colorectal | Education, housing, income, education | K: Symptom interpretation (best knowledge for breast cancer patients) B: Fear (16.8 % of delayers) PB: ‘’thought it would go away” (60.5 % of delayers), too busy (8.4 % of delayers) SP: Waited over 3 months to seek medical help: lung (54.9 %), breast (56.2 %), colorectal (87.6 %) | K: NR B: NR PB: NR SP: NS relationship between socioeconomic group and time to SP (statistics NR) | Medium |
Oliveria et al. (1999) [37] | Retrospective Quantitative | 255 men and women. Aged 18 years and over | US | Melanoma | Education, insurance | K: Recognition (poor) SP: Mean time to symptom presentation (2 months) | K: NR SP: Education not associated with time to SP (statistics NR) | Medium |
O’Mahony and Hegarty (2009) [47] | Retrospective Quantitative | 99 women. Mean age: 40 years | Ireland | Breast | Employment, education | K: Symptom interpretation PB: Competing life priorities, emotional reactions to symptom (afraid, scared, unsure) PF: Symptom disclosure, anxiety SP: Waited over 1 month to seek medical help (n = 26) | K: NR PB: NR PF: NR SP: Higher education associated with longer time to SP (statistics NR) | Medium |
O’Mahony et al. (2011) [79] | Retrospective Qualitative | 10 women. Mean age: 40 years | Ireland | Breast | Education, employment, insurance | K: Most aware that a lump was a symptomof cancer B: Fatalism, curability of cancer, fear PB: Denial, competing life priorities PF: Symptom disclosure, good perceived access to GP, good relationship with GP SP: Sought medical help within 1 month (n = 6) | Medium | |
Pedersen et al. (2011) [85] | Retrospective Quantitative | 901 men (n = 423) and women (n = 487). Mean age: 61.8 years | Denmark | All | Education | PF: Symptom disclosure, good partner support SP: Median interval: 12 days | PF: NR SP: NS association between education and time to SP: Lower secondary education and long SP (>55 days) (RRR 0.79, 95 % CI: 0.36-1.74, p > 0.05); tertiary education and long SP (>55 days) (RRR 1.30, 95 % CI: 0.55-3.08, p > 0.05) | Medium |
Quaife et al. (2014) [32] | Hypothetical Quantitative | 6965 men (n = 4330) and women (n = 265). Aged 50 and over | UK | All | Education | K: Recognition (best for ‘lump’) PB: Poor access health services SP: Would wait 2+ weeks: (cough, n = 48.1 %; breast change, n = 8.2 %; rectal bleeding, n = 7.4 %) | K: Lower education associated with lower recognition for all 3 symptoms (x2, p < 0.05**) PB: NR SP: Lower education associated with shorter time to SP for cough (OR 0.61, 95 % CI: 0.54-0.68, p < 0.001) and breast changes (OR 0.68, 95 % CI: 0.52-0.89, p < 0.001). NS association with education and time to SP for rectal bleeding (OR 0.83, 95 % CI: 0.67-1.03, p > 0.05) | Good |
Rauscher et al. (2010) [66] | Retrospective Quantitative | 438 women. Age range: 30 to 79 years | US | Breast | Education, household income, health insurance status | K: Breast lump misconceptions (20 % reported one or more misconception) PB: Poor general health service utilisation SP: Waited over 3 months to seek medical help (16 %) | K: Lower income and education associated with more breast lump misconceptions (x2, p < 0.001**) PB: NR SP: Longer time to SP associated with lower education (x2, p < 0.05**) and lower income (x2, p < 0.05**) | Medium |
Richard et al. (2000) [77] | Retrospective Quantitative | 590 men (n = 250) and women (n = 340). Mean age: 51.2 years | France | Melanoma | Residence, social level, education | K: Symptom interpretation (‘not serious’, 34.8 %) B: Fear PB: No symptoms, competing life priorities (work and family commitments), melanoma not detected by participant PF: Active encouragement from family SP: Sought medical help within 2 months (51.9 %) | K: NS B: NS PB: Those with higher education more likely to self-detect melanoma (x2, p < 0.01**) PF: NR SP: NS association with and time to SP and socioeconomic group (statistics NR) | Medium |
Rozniatowski et al. (2005) [73] | Retrospective Quantitative | 100 men (n = 84) and women (n = 16). Mean age: 57 years | France | Head and Neck | Education, occupation | PB: Low anxiety, poor general health service utilisation PF: Symptom disclosure, active encouragement from partner to seek help SP: The majority of patients waited over 1 week to seek medical help | K: NR PB: NR SP: NS association between socioeconomic group and time to SP (statistics NR) | Medium |
Ristvedt et al. (2014) [33] | Retrospective Quantitative | 112 men (n = 55) and women (n = 57). Mean age: 59.3 years | US | Colorectal | Income, area of residence, education, health insurance | K: Symptom interpretation (70.5 % thought symptom serious within 13 weeks post onset) SP: Median time to symptom presentation (10 weeks) | K: NR SP: NS association between socioeconomic group (education and household income) and time to SP (statistics NR) | Medium |
Ristvedt and Trinkhaus (2005) [9] | Retrospective Quantitative | 69 men (n = 42) and women (n = 27). Mean age: 61.3 years | US | Colorectal | Education | K: Symptom interpretation (‘not cancer’, 71 %) PB: Personality (low trait anxiety), poor health service utilisation SP: Mean time to symptom presentation (25 weeks) | K: NR PB: NR SP: Lower education associated with longer time to SP (Kaplan-Meier: median 15 weeks, 95 % CI: 9.0-26.0*); higher education associated with shorter time to SP (Kaplan-Meier: median 8 weeks, 95 % CI: 4.0-15.0*) | Medium |
Robb et al. (2009) [19] | Hypothetical Quantitative | 2216 men (n = 968) and women (n = 1240) | UK | All | Education, occupation | K: Recall (poor, mean = 2.2) and recognition (good, mean = 7.2) PB: Emotional and service barriers most endorsed SP: Most would seek medical help within 2 weeks | K: Higher socioeconomic group (occupation) associated with highest knowledge (F (2,2015) = 20.31, p < 0.001) PB: Lower socioeconomic group (occupation) associated with more emotional barriers endorsed: ‘worry what the doctor might find’ (x2 (1,1989) = 17.08, p < 0.001), ‘too embarrassed’ (x2 (1,1993) = 20.74, p < 0.001), ‘not confident to talk about symptom’ (x2 (1,1992) = 4.77, p < 0.05), NS association with ‘too scared’ (x2 (1,1977) = 1.82, p > 0.05); Higher socioeconomic group (occupation) associated with more practical barriers endorsed: ‘too busy’ (x2 (1,2005) = 59.0, p < 0.001), ‘other things to worry about’ (x2(1,1996) = 15.34, p < 0.001), ‘difficult to arrange transport’ (x2(1,2010) = 11.13, p < 0.001); NS association between socioeconomic group (occupation) and service barriers: ‘difficult to make appointment’ (x2 (1,1983) = 0.41, p > 0.05), ‘worried about wasting the doctors time’ (x2 (1,1995) = 1.44, p > 0.05), ‘difficult to arrange transport’ (x2 (1,1938) = 1.15, p > 0.05) SP: Lower socioeconomic group (occupation) associated with shorter time to SP for unexplained bleeding (x2 (1,1991) = 5.82, p < 0.01), difficulty swallowing (x2 (1,1987) = 28.41, p < 0.001), lump (x2(1,1988) = 21.26, p < 0.001), change in mole (x2 (1,1967) = 24.24, p < 0.001), unexplained pain (x2(1,1965) = 20.24, p < 0.001), sore that does not heal (x2 (1,1977) = 35.84, p < 0.001), change in bowel/bladder habits (x2 (1,1982) = 56.87, p < 0.001), cough (x2 (1,1984) = 48.32, p < 0.001), unexplained weight loss (x2 (1,1963) = 77.73, p < 0.001) | Good |
Samet et al. (1988) [62] | Retrospective Quantitative | 800 men (n = 396) and women (n = 404). Mean age: 72.2 years | US | All | Education, income | PB: Poor general health service utilisation, poor access SP: Most sought medical help within 2 months | PB: NR SP: Longer time to SP associated with lower income for breast and colorectal cancer (x2, p < 0.05**) and lower education for all tumour sites (x2, p < 0.05**) | Medium |
Schmid-Wendter (2002) [40] | Retrospective Quantitative | 233 men (n = 109) and women (n = 109). Mean age: 54.5 years | Germany | Melanoma | Education | K: Previous knowledge of melanoma, symptom interpretation B: Fear PB: Lesion not visible, too busy SP: Sought medical help within 1 month (15.5 %) | K: Higher education more likely to have knowledge about melanoma (x2, p < 0.001**) B: NR PB: NR SP: NR | Medium |
Siminoff et al. (2014) [35] | Retrospective Mixed methods | 252 men (n = 132) and women (n = 120). Mean age: 58 years (range 25 to 94 years) | US | Colorectal | Education, Employment, Income | K: Symptom interpretation (39.7 % did not think symptom was serious) PB: Financial barriers (28.6 %), fear of diagnostic tests (24.3 %), embarrassment (11.9 %) SP: Mean appraisal delay (4.8 months) | K: NR PB: NR SP: NS association between time to SP and socioeconomic group (statistics NR) | Medium |
Simon et al. (2010) [49] | Retrospective Quantitative | 236 men (n = 968) and women (n = 1240). 11.4 % (n = 236) had experienced a symptom in the past 3 months | UK | All | Occupation | K: Recognition (better knowledge if experienced a symptom previously); symptom interpretation (worry symptom might be cancer) PB: Emotional and practical barriers SP: Symptom experience: 11.4 % experienced symptom in past 3 months (75 % consulted a GP about symptom) | K: NS association between symptom interpretation and socioeconomic group (statistics NR) PB: NR SP: NS association between SP and socioeconomic group (statistics NR) | Good |
Smith and Anderson (1985) [51] | Retrospective Quantitative | 82 women. Age range: 20 to 54 years | US | Ovarian | Income, education, occupation | K: Symptom interpretation (‘cancer’, 10 %) B: Fear PB: Previous benign diagnosis SP: Median time to symptom presentation (4 weeks) | K: NS association between symptom interpretation and socioeconomic group (statistics NR) B: NR PB: NR SP: NR | Medium |
Temoshok et al. (1983) [75] | Retrospective Quantitative | 106 men and women. Age range: 18 to 72 years. | US | Melanoma | Education, occupation | K: Previous knowledge of melanoma B: Melanoma not a serious disease PF: Lesion visible (face and neck) SP: Mean time to symptom presentation (4 months) | K: No association with knowledge and occupation (statistics NR) B: NR PF: NR SP: No association with time to SP and occupation (statistics NR) | Poor |
Tod et al. (2008) [80] | Retrospective Qualitative | 20 men (n = 12) and women (n = 8). | UK | Lung | Occupation | K: Symptom interpretation (poor, symptoms usually interpreted as acute conditions) B: Fear, fatalism PB: If previously given up smoking (thought risk of lung cancer was nil), worry about the wasting doctors time, previous bad experiences with health system, blame, stigma, stoicism, poor health service utilisation PF: Active encouragement from family member SP: Range in time to symptom presentation (0 to 24 months) | Good | |
Tomlinson et al. (2012) [60] | Retrospective Quantitative | 87 men (n = 56) and women (n = 31). Mean age: 65 years. | Canada | Colorectal | Education | K: Symptom interpretation PB: Self medication SP: Waited over 1 month to seek medical help (51 %) | K: NR PB: NR SP: NS association between education and time to SP (x2, p > 0.05**) | Medium |
Trivers et al. (2011) [52] | Hypothetical Quantitative | 2991 women. 65 % were aged 45 years and over. | US | Gynaeco-logical | Education, Income | B: Concern about developing gynaecological cancer PB: Being premenopausal SP: 50 % of women would seek help for most symptoms | B: NR PB: NR SP: NS association between SP intentions and socioeconomic group (statistics NR) | Medium |
Van Osch et al. (2007) [48] | Hypothetical Quantitative | 459 men (49 %) and women (51 %) over the age of 55. Mean age: 68.6 years. | Netherlands | All | Education | K: Recognition (low to moderate, mean: 6.2) B: Benefits of early detection SP: Fair. Inconsistent for urgent symptoms, good for prolonged symptoms | K: NR B: NR SP: Lower education associated with shorter time to SP (F (2,436) =6.084, p < 0.01) | Good |
Waller et al. (2009) [53] | Hypothetical Quantitative | 1500 men and women from various ethnic minority groups. | England | All | Occupation | K: Recall (poor, mean: 1.2) and recognition (poor, mean: 4.7) PB: Worry what doctor might find (most endorsed) SP: African and Caribbean groups anticipated fastest time to symptom presentation | K: Higher socioeconomic group associated with higher recall (F(1,1487) = 6.12, p < 0.01) and higher recognition (F (1,1487) = 5.45, p < 0.05) PB: NR SP: NR | Good |
Walter et al. (2014) [41] | Retrospective Qualitative | 63 men (n = 31) and women (n = 32). Age range: 29-93 years. | UK | Melanoma | Education | K: Symptom attributions (initially attributed to benign skin conditions or normal life changes) PB: Worry about wasting the doctors time, service barriers, competing life priorities, reassurance following symptom disclosure PF: Family history of melanoma, perceptions of high risk, symptom disclosure, symptom noticed by another person SP: Range 1-303 weeks | Good | |
Whitaker et al. (2014) [55] | Retrospective Quantitative | 1724 men (n = 789) and women (n = 921) over the age of 50. Mean age: 64.4 years. | England | All | Postcode, education, employment | K: Symptom interpretations (2 % thought symptom was cancer, highest interpretation for ‘unexplained lump’), perceived seriousness of symptoms SP: Symptom experience (53 % experienced at least 1 symptom in past 3 months). 59 % contacted GP about symptom | K: Unemployment associated with higher perceived seriousness of pain (OR 2.26, 95 % CI: 1.17-4.35, p < 0.05), tiredness (OR 2.11, 95 % CI:1.23-3.64, p < 0.05), sore throat (OR 3.56, 95 % CI: 1.10-11.45, p < 0.05) and chest pain (OR 3.56, 95 % CI: 1.10-11.45, p < 0.05). Lower education associated with higher perceived seriousness cough (OR 2.25, 95 % CI: 1.10-4.56, p < 0.05), tiredness (OR 2.46, 95 % CI:1.44-4.21, p < 0.05), headaches (OR 3.80, 95 % CI: 1.63-8.89, p < 0.05), shortness of breath (OR 2.34, 95 % CI: 1.11-4.97, p < 0.05), sore throat (OR 4.16, 95 % CI: 1.14-15.22, p < 0.05) and chest pain (OR 4.16, 95 % CI: 1.13-15.22, p < 0.05) SP: NR | Good |
Whitaker et al. (2015) [81] | Retrospective Qualitative | 48 men (n = 23) and women (n = 25) over the age of 50. Mean age: 64.4 years. | England | All | Education, employment | K: Symptom interpretations (symptoms normalised or associated with cancer) PB: Stoicism, fear of diagnostic tests, worry about wasting doctors time, service barriers, negative attitudes towards HCPs, medical mistrust PF: Development of new symptoms, persistence of symptoms, symptom disclosure, fear SP: Varied per symptom: 33.3 % contacted GP with ‘persistent cough’, 100 % contacted GP with ‘unexplained bleeding’ | Good |