Scott Suzanne E, McGurk Mark, Grunfeld Elizabeth A
Health Psychology Section, Department of Psychology, Institute of Psychiatry, King's College London, London, United Kingdom.
J Psychosom Res. 2007 Jun;62(6):621-30. doi: 10.1016/j.jpsychores.2006.12.020.
Following the self-discovery of symptoms of oral cancer, approximately 30% of patients wait for more than 3 months before seeking attention from a health care professional. Although symptom appraisal is known to be an important stage in the decision to seek help, little is known about the process of symptom appraisal. The aims of the current study were to produce a theory-guided investigation of the specific cognitive interpretations and emotional reactions to the self-discovery of potentially malignant oral symptoms and to gain understanding as to why these may change prior to help seeking.
In-depth semi-structured interviews were conducted with 57 consecutive patients who had been referred with potentially malignant oral symptoms. Participants were asked about symptom detection, initial and subsequent beliefs about symptoms, and emotional responses prior to their first visit to a health care professional. The tape-recorded interviews were transcribed verbatim and analyzed using "framework analysis."
Patients often attributed the symptoms to transient, minor conditions such as mouth ulcers, physical trauma, or dental problems and, in turn were unconcerned about their presence. Patients infrequently attributed their symptoms to cancer. Origins of specific interpretations included previous experiences, specific symptomatology, logical associations with the perceived cause, and information from medical literature. Stimuli for reinterpretation included receipt of new information, symptom development, and persistence of symptoms.
This study has documented the process of symptom appraisal and indicates that an individual's interpretation of potentially malignant oral symptoms is often misguided.
在自我发现口腔癌症状后，约30%的患者会等待3个月以上才寻求医疗专业人员的关注。尽管症状评估被认为是决定寻求帮助的一个重要阶段，但对于症状评估的过程却知之甚少。本研究的目的是对潜在恶性口腔症状自我发现的具体认知解释和情绪反应进行理论指导的调查，并了解在寻求帮助之前这些反应可能发生变化的原因。
对57例因潜在恶性口腔症状前来就诊的连续患者进行了深入的半结构化访谈。询问参与者关于症状的发现、对症状的初始和后续看法，以及在首次就诊于医疗专业人员之前的情绪反应。对录音访谈进行逐字转录，并使用“框架分析”进行分析。
患者常将症状归因于短暂的、轻微的情况，如口腔溃疡、身体创伤或牙齿问题，因此对这些症状并不担心。患者很少将症状归因于癌症。具体解释的来源包括既往经历、特定症状、与感知病因的逻辑关联以及医学文献中的信息。重新解释的刺激因素包括收到新信息、症状发展和症状持续。
本研究记录了症状评估的过程，并表明个体对潜在恶性口腔症状的解释往往存在误导。
