Making sense of bodily sensations: do shared cancer narratives influence symptom appraisal?

Macdonald, S. , Conway, E., Bikker, A., Browne, S. , Robb, K. , Campbell, C., Steele, R. J.C., Weller, D. and MacLeod, U. (2019) Making sense of bodily sensations: do shared cancer narratives influence symptom appraisal? Social Science and Medicine, 223, pp. 31-39. (doi: 10.1016/j.socscimed.2018.12.034) (PMID:30703697)

177709.pdf - Accepted Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.



Though new or altered bodily sensations are a common occurrence they rarely transition to biomedically defined symptoms. When they do, sensations are subject to an appraisal process that can culminate in help-seeking. The transition has particular relevance for cancer diagnoses. Studies of 'symptom appraisal' in cancer patients typically conclude that failure to regard sensations as serious or 'symptom misattribution' results in lengthier help-seeking intervals. Though multiple influences on appraisal processes are acknowledged, including the socio-cultural context, detailed description and analyses of how socio-cultural factors shape appraisal is lacking. In this paper we explore one substantial component of the sociocultural context, namely, publicly recognised shared cancer narratives, and their impact on appraisal. We undertook a secondary analysis of 24 interviews with Scottish colorectal cancer patients originally completed in 2006–2007. Our analysis showed that fear, death and severity dominated cancer narratives and were frequently restated throughout interviews. Yet, early bodily changes were often mild and vague, were commonly experienced in the context of 'feeling well' and failed to match preconceived ideas of what cancer 'feels like'. Moreover, few perceived themselves to be 'at risk' of cancer and diagnoses were characterised as 'shocking' events. Participants engaged in self-monitoring strategies and severe or painful changes prompted help-seeking. Far from misattributing symptoms, responses to bodily changes were sensible and measured; responses are particularly apt in relation to current policy rhetoric, which urges measured use of services. Our findings have resonance across healthcare settings as patients are required to negotiate a narrow and challenging space when making decisions to seek help. There is a pressing need for a more realistic approach to symptom appraisal in order to reduce help-seeking intervals. Future awareness campaigns should emphasise the importance of vague/minor bodily changes although this will necessitate discussions with health professionals on referral thresholds to achieve earlier detection.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Conway, Dr Elaine and MacLeod, Dr Una and Bikker, Ms Annemieke and Browne, Dr Susan and Robb, Professor Katie and Macdonald, Professor Sara
Authors: Macdonald, S., Conway, E., Bikker, A., Browne, S., Robb, K., Campbell, C., Steele, R. J.C., Weller, D., and MacLeod, U.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
Journal Name:Social Science and Medicine
ISSN (Online):0277-9536
Published Online:10 January 2019
Copyright Holders:Copyright © 2019 Elsevier
First Published:First published in Social Science and Medicine 223: 31-39
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

University Staff: Request a correction | Enlighten Editors: Update this record

Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
612251Improving early detection of colorectal cancer: the role of candidacySara MacDonaldOffice of the Chief Scientist (CSO)CZH/4/890IHW - GENERAL PRACTICE & PRIMARY CARE