Evans Julie, Chapple Alison, Salisbury Helen, Corrie Pippa, Ziebland Sue
Health Experiences Research Group, Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
BMJ Open. 2014 Feb 18;4(2):e004215. doi: 10.1136/bmjopen-2013-004215.
This article explores how people with pancreatic cancer interpreted prediagnostic signs and symptoms, and what triggered them to seek medical help for symptoms that occurred intermittently.
Thematic analysis of prediagnostic symptom descriptions drawn from a qualitative interview study of people with experiences of pancreatic cancer.
40 people affected by pancreatic cancer (32 patients and 8 relatives of people who had died). Age at interview ranged from 35 to 84 years; 55% were men; and 57.5% of patients had been offered potentially curative surgery.
Respondents interviewed at home were recruited from different parts of the UK during 2009/2010.
Analysis of the interviews suggested that intermittent symptoms were not uncommon in the months, or even years, before diagnosis but that the fact that the symptom did not persist was often taken by the patient as a reassuring indicator that it could not be 'very important'. Such symptoms were rarely acted upon until a pattern became apparent, the frequency of symptom episodes increased, there was a change in the nature of the intermittent symptoms or additional symptom(s) appeared. These findings build on social science theories of consultation behaviour.
Our study-the largest reported collection of qualitative interviews with people with pancreatic cancer-reports for the first time that symptoms of an intermittent nature may precede a pancreatic cancer diagnosis. Patients (and potentially their doctors as well) may be falsely reassured by symptoms that come and go. Pancreatic cancer might be identified at a stage where curative treatment is more likely if there were greater awareness that intermittent gastrointestinal symptoms can have a serious cause, and if patients with intermittent pancreatitis-like symptoms were investigated more readily.
本文探讨胰腺癌患者如何解读诊断前的体征和症状，以及是什么促使他们就间歇性出现的症状寻求医疗帮助。
对胰腺癌患者定性访谈研究中提取的诊断前症状描述进行主题分析。
40名胰腺癌患者（32名患者及8名患者亲属）。访谈时年龄在35至84岁之间；55%为男性；57.5%的患者接受了可能治愈性的手术。
2009年至2010年期间，在家中接受访谈的受访者招募自英国不同地区。
访谈分析表明，间歇性症状在诊断前数月甚至数年并不罕见，但症状未持续这一事实往往让患者放心，认为其“不太重要”。在症状模式变得明显、症状发作频率增加、间歇性症状性质改变或出现其他症状之前，这些症状很少会引起行动。这些发现基于咨询行为的社会科学理论。
我们的研究——最大规模的关于胰腺癌患者定性访谈的报道——首次报告间歇性症状可能先于胰腺癌诊断出现。症状时有时无可能会让患者（以及潜在地让他们的医生）产生错误的安心感。如果能更清楚地认识到间歇性胃肠道症状可能有严重病因，并且对有间歇性胰腺炎样症状的患者更容易进行检查，那么胰腺癌可能在更有可能进行治愈性治疗的阶段被发现。
