Symptom Attribution, Help Seeking and Willingness to Undergo Diagnostic Investigations for Bowel Cancer Symptoms in People With Anxiety and/or Depression-A Vignette Study.

Abstract

Background: Bowel cancer is a common cause of cancer deaths and survival increases dramatically with earlier diagnosis. People with mental health problems such as anxiety and/or depression (A/D) are less likely to engage in health behaviours important for early detection.

Aims: We explored whether three processes crucial for early cancer diagnosis are different in the A/D group compared to controls: (1) 'attributions' that is, assumed causes of bodily changes typical for bowel cancer, (2) help seeking actions participants would be likely to take and (3) willingness to do a relevant test (stool test or sigmoidoscopy/colonoscopy).

Methods: In this randomised online vignette study, 1883 participants were presented one of four scenarios that each featured one bodily change typical of bowel cancer. Attributions were indicated using a free text response option. Help seeking options were presented in a list and likelihood of engaging in them was explored. Willingness to take a test was assessed using a question with response options 'yes', 'no' and 'unsure'.

Results: Participants with A/D were more likely to attribute symptoms to their mental health than to cancer. Male participants with A/D were less likely to engage in several help-seeking actions. Participants in the A/D group were less likely to be willing to undergo invasive diagnostic testing.

Conclusions: People with A/D should be encouraged to take bodily changes typical of cancer seriously and be proactive in help seeking and taking tests. Clinicians need to be aware that people with A/D may misattribute bodily changes associated with cancer and support them to seek help and undergo testing.