Reader in Applied Health Research, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
PhD student, School of Health Sciences, University of Surrey, Guildford, UK.
Prim Health Care Res Dev. 2023 Apr 11;24:e26. doi: 10.1017/S1463423623000129.
We undertook a rapid review of literature relating to the diagnosis of blood cancers, to find out what factors contribute to delays in diagnosis, including symptom recognition, appraisal and help-seeking behaviours.
We used rapid review methodology following Tricco to synthesise current literature from two electronic databases. We searched for studies about symptom appraisal help-seeking for all blood cancers published between 2001 and 2021, written in English.
Fifteen studies were included in the review, of which 10 were published in the United Kingdom. We found a number of factors associated with delays in blood cancer diagnosis. These included patient factors such as gender, age and ethnicity, as well as health system factors such as poor communication and seeing a locum clinician in primary care. A narrative synthesis of the evidence produced four types of symptom interpretation by patients: (1) symptoms compatible with normal state of health, (2) event-linked problems, (3) mild or chronic illness and (4) non-specific unwell state. These four interpretations were linked to different help-seeking behaviours. After seeking help, patients often experienced delays due to healthcare professionals' (HCPs') non-serious interpretation of symptoms, misleading blood tests, discontinuity of care and other barriers in the diagnostic pathway.
Blood cancers are difficult to diagnose due to non-specific heterogeneous symptoms, and this is reflected in how those symptoms are interpreted by patients and managed by HCPs. It is important to understand how different interpretations affect delays in help-seeking, and what HCPs can do to support timely follow-up for patients.
我们对与血液癌症诊断相关的文献进行了快速综述，以了解导致诊断延迟的因素，包括症状识别、评估和寻求帮助的行为。
我们使用特立科（Tricco）的快速综述方法，从两个电子数据库中综合当前文献。我们搜索了 2001 年至 2021 年间发表的关于所有血液癌症的症状评估寻求帮助的研究，这些研究用英语撰写。
综述共纳入了 15 项研究，其中 10 项发表在英国。我们发现了一些与血液癌诊断延迟相关的因素。这些因素包括患者因素，如性别、年龄和种族，以及卫生系统因素，如沟通不良和在初级保健中看临时医生。对证据的叙述性综合产生了患者对症状的四种解释类型：（1）与健康状态一致的症状，（2）与事件相关的问题，（3）轻度或慢性疾病，以及（4）非特异性不适状态。这四种解释与不同的寻求帮助行为有关。寻求帮助后，由于医疗保健专业人员（HCPs）对症状的非严重解释、误导性的血液测试、护理的不连续性以及诊断途径中的其他障碍，患者经常会出现延迟。
由于非特异性异质症状，血液癌症难以诊断，这反映在患者对这些症状的解释以及 HCPs 的管理方式上。了解不同的解释如何影响寻求帮助的延迟，以及 HCPs 可以做些什么来支持患者的及时随访，这一点很重要。
