Using the candidacy framework to understand how doctor-patient interactions influence perceived eligibility to seek help for cancer alarm symptoms: a qualitative interview study

• Published in: BMC health services research Vol. 18; no. 1; p. 937
• Main Authors: Tookey, Sara, Renzi, Cristina, Waller, Jo, von Wagner, Christian, Whitaker, Katriina L
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 04.12.2018; BioMed Central; BMC
• Subjects: Aged; Appointments and Schedules; Cancer; Cancer treatment; Candidacy; Communication; Data analysis; Decision making; Early Detection of Cancer; Early diagnosis of cancer; Eligibility Determination; Female; General Practice - statistics & numerical data; General practitioners; Health care access; Health care services accessibility; Health services; Health Services Accessibility - statistics & numerical data; Help-seeking behaviour; Humans; Interviews; Lung cancer; Male; Management; Medical diagnosis; Medical referrals; Middle Aged; Neoplasms - diagnosis; Neoplasms - psychology; Pain; Patient Acceptance of Health Care - psychology; Patient-centered care; Patients; Perception; Permeability; Physician-Patient Relations; Practice; Primary care; Primary health care; Primary Health Care - statistics & numerical data; Qualitative Research; Referral and Consultation; Signs and symptoms; Time Factors; Qualitative research; Early diagnosis of cancer; Signs and symptoms; Candidacy; Help-seeking behaviour; Primary health care
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-018-3730-5

'Candidacy' is concerned with the way people consider their eligibility for accessing health services. We used the Candidacy Framework to explore how the doctor-patient relationship can influence perceived eligibility to visit their General Practitioner (GP) among people experiencing cancer alarm symptoms. We carried out a secondary analysis of qualitative interviews with 29 women and 33 men, aged ≥50 years experiencing cancer alarm symptoms, recruited through primary care. Interviews focused on symptom experience, help-seeking and primary care use. Framework analysis was used to analyse transcripts with a focus on GP-patient interactions. Perceived (im)permeability of services acted as a barrier to help-seeking, due to limited availability of appointments, time-limited communication and difficulties asserting candidacy. There was also a focal role of communication in building a positive doctor-patient relationship, with some participants describing resisting offers of appointments as a result of previous negative GP adjudication. These factors not only influenced the current consultation but had longer-term consequences for future consultation. Candidacy provides a valuable theoretical framework to understand the interactional factors of the doctor-patient relationship which influence perceived eligibility to seek help for possible cancer alarm symptoms. We have highlighted areas for targeted interventions to improve patient-centred care and improve earlier diagnosis.