Psychological factors related to time to help-seeking for cancer symptoms: A meta-analysis across cancer sites.

The time patients wait before seeking help for cancer symptoms is among the most important factors contributing to diagnostic delays in cancer. We reviewed the association between time to help-seeking and three psychological factors: symptom knowledge, symptom interpretation, and beliefs about cancer (Prospero review protocol CRD42018088944). Forty-seven studies published between 1990 and 2019 met the inclusion criteria, providing data on 44,961 participants from 22 countries concerning seven cancer sites. A series of random-effects meta-analyses and meta-regressions were conducted. Better symptom knowledge was related to lower odds of a long help-seeking interval in both studies with healthy populations (OR = .73, 95% CI [.63, .84], k = 19) and with patients (OR = .40, 95% CI [.23, .69], k = 12), and so was interpreting experienced symptoms as cancer-related (OR = .52, 95% CI [.36, .75], k = 13 studies with patients). More positive beliefs about cancer (i.e., that cancer is treatable) were associated with lower odds of a long help-seeking interval in both studies with healthy populations (OR = .70, 95% CI [.52, .92], k = 11) and with patients (OR = .51, 95% CI [.32, .82], k = 7). Symptom knowledge, interpretation, and beliefs about cancer are likely to be universal predictors of help-seeking. Theoretical models of patient help-seeking and interventions aiming to reduce delays should incorporate these factors.