Renzi Cristina, Whitaker Katriina L, Wardle Jane
Department of Epidemiology and Public Health, University College London, Health Behaviour Research Centre, London, UK.
BMJ Open. 2015 Feb 4;5(2):e007002. doi: 10.1136/bmjopen-2014-007002.
This literature review examined research into the impact of a previous 'all-clear' or non-cancer diagnosis following symptomatic presentation ('false alarm') on symptom attribution and delays in help seeking for subsequent possible cancer symptoms.
The comprehensive literature review included original research based on quantitative, qualitative and mixed data collection methods. We used a combination of search strategies, including in-depth searches of electronic databases (PubMed, EMBASE, PsychInfo), searching key authors and articles listed as 'related' in PubMed, and reference lists. We performed a narrative synthesis of key themes shared across studies.
The review included studies published after 1990 and before February 2014 reporting information on adult patients having experienced a false alarm following symptomatic presentation. We excluded false alarms in the context of screening.
We evaluated the effect of a 'false alarm' on symptom attribution and help seeking for new or recurrent possible cancer symptoms.
Overall, 1442 papers were screened and 121 retrieved for full-text evaluation. Among them, 19 reported on false alarms and subsequent symptom attribution or help seeking. They used qualitative (n=14), quantitative (n=3) and mixed methods (n=2). Breast (n=7), gynaecological (n=3), colorectal (n=2), testicular (n=2), and head and neck cancers (n=2) were the most studied. Two broad themes emerged underlying delays in help seeking: (1) over-reassurance from the previous 'all-clear' diagnosis leading to subsequent symptoms being interpreted as benign, and (2) unsupportive healthcare experiences in which symptoms were dismissed, leaving patients concerned about appearing hypochondriacal or uncertain about the appropriate next actions. The evidence suggested that the effect of a false alarm can persist for months and even years.
In conclusion, over-reassurance and undersupport of patients after a false alarm can undermine help seeking in the case of new or recurrent potential cancer symptoms, highlighting the need for appropriate patient information when investigations rule out cancer.
本综述研究了有症状表现后先前的“一切正常”或非癌症诊断（“误报”）对症状归因以及后续可能出现的癌症症状寻求帮助的延迟的影响。
全面的文献综述包括基于定量、定性和混合数据收集方法的原始研究。我们使用了多种搜索策略，包括深入搜索电子数据库（PubMed、EMBASE、PsychInfo）、搜索关键作者以及PubMed中列为“相关”的文章和参考文献列表。我们对各项研究共有的关键主题进行了叙述性综合分析。
该综述纳入了1990年后至2014年2月前发表的研究，这些研究报告了有症状表现后经历过误报的成年患者的信息。我们排除了筛查背景下的误报情况。
我们评估了“误报”对症状归因以及针对新的或复发的可能癌症症状寻求帮助的影响。
总体而言，共筛选了1442篇论文，检索出121篇进行全文评估。其中，19篇报告了误报及后续的症状归因或寻求帮助情况。这些研究采用了定性（n = 14）、定量（n = 3）和混合方法（n = 2）。研究最多的癌症类型包括乳腺癌（n = 7）、妇科癌症（n = 3）、结直肠癌（n = 2）、睾丸癌（n = 2）以及头颈癌（n = 2）。出现了两个导致寻求帮助延迟的广泛主题：（1）先前 “一切正常” 的诊断带来过度安慰，导致后续症状被解释为良性；（2）医疗保健体验不佳，症状被忽视，使患者担心自己显得疑病症或对下一步适当行动感到不确定。证据表明，误报的影响可能持续数月甚至数年。
总之，误报后对患者的过度安慰和支持不足可能会破坏在出现新的或复发的潜在癌症症状时寻求帮助的行为，这凸显了在检查排除癌症时提供适当患者信息的必要性。
