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Understanding the health behaviour behind GP help-seeking with potential cancer symptoms.

Project Description

1. Background to the project.
It is widely believed that a root cause of poorer UK cancer survival, in comparison to other parts of the developed world, rests in longer delays in the component parts of the cancer diagnostic pathway here compared to elsewhere.[1,2] A possible reason relates to the fact that specific groups of patients are slow to seek medical help when they develop cancer-related symptoms and show a greater tendency to be diagnosed with cancer following an emergency presentation.[3,4] This has been also suggested by several qualitative studies grounded in current theories from health psychology.[5-8] Considerable resource has been invested in public awareness campaigns about cancer but there is little current evidence of their effectiveness to promote earlier health seeking and improve cancer outcomes in the UK, as there is little understanding of which specific patient groups delay help-seeking for which particular potential cancer symptoms and the underlying mechanism behind their behaviour. [9-10]

2. Proposed research and techniques.
The student will work under the supervision of an academic GP, a psychologist, and a medical statistician, who together will provide expertise on cancer diagnosis within primary care, symptom experience and health behaviour, data-linkage and advanced statistical analysis. The student’s work will be based on the USEFUL cohort, a community-based cohort of approximately 20,000 people drawn from across the UK. Subjects in the USEFUL cohort have provided detailed information about their current experience of, and response to, 25 potential symptoms of cancer. The USEFUL cohort enables a unique insight into the prevalence of potential cancer symptoms within the UK population as well as how these symptoms are differentially experienced by and responded to by people with different demographic characteristics.

This PhD project has three stages:

First, the student will conduct a systematic review of the psychological mechanisms underpinning GP help-seeking. [7]

Second, the student will perform a detailed statistical exploration of demographic, socio-economic psychological and health-related differences in symptom prevalence (for symptoms reported within the previous month), as well as investigating any association of these variables and GP help-seeking amongst the USEFUL cohort [6] from 20,000 UK adults.

Third, the student will conduct in-depth face-to-face qualitative interviews with older people and health professionals exploring barriers to help-seeking behaviours with different (potentially cancer-related) symptoms.

Once synthesised the findings of the project will contribute to a developing a programme of work which seeks to improve awareness and motivate help-seeking to cancer-related symptoms in the UK and give insight on how healthcare services’ current organization can best be improved to meet the needs of those patients that might have cancer.

3. Useful previous experience for the studentship.
This project will suit a student with a basic grounding in clinical science. An understanding of cancer, health psychology, medical statistics, data-handling and a willingness to learn and develop new expertise and skills will be essential. Good scientific writing skills and practical experience of statistical analysis and literature review will also be essential. Experience of advanced statistical methods and database management will be highly desirable, as will experience with R software.

This project is advertised in relation to the research areas of APPLIED HEALTH SCIENCE. Formal applications can be completed online: You should apply for Degree of Doctor of Philosophy in Applied Health Science, to ensure that your application is passed to the correct person for processing.


Funding Notes

This project is for self-funded applicants only – there is no funding attached.

For details of fees: View Website

Candidates should have (or expect to achieve) a minimum of a 2.1 Honours degree in a relevant subject. Applicants with a minimum of a 2.2 Honours degree may be considered provided they have a Merit/Commendation/Distinction at Masters level.


1. Coleman MP, Forman D, Bryant H, et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995-2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. Lancet 2011; 377: 127-138.
2. Richards MA. The National Awareness and Early Diagnosis Initiative in England: assembling the evidence. British Journal of Cancer 2009; 101: S1-S4.
3. Macleod U, Mitchell ED, Burgess C, et al. Risk factors for delayed presentation and referral of symptomatic cancer: evidence for common cancers. British Journal of Cancer 2009; 101: S92-S101
4. Murchie P, Smith S, Yule M, et al. Does emergency presentation of cancer represent poor performance in primary care? Insights from a novel analysis of linked primary and secondary care data. Brit J Cancer 2017;116:1148-1158 Published Online Mar 23rd – DOI 10.1038/bjc.2017.71.
5. Corner J, Hopkinson J, Fitzsimmons D, et al. Is late diagnosis of lung cancer inevitable? Interview study of patients’ recollections of symptoms before diagnosis. Thorax 2005; 60: 314-319.
6. Smith LK, Pope C, Botha J. Patient’s help-seeking experiences and delay in cancer presentation: a qualitative synthesis. Lancet 2005; 366: 825-831.
7. Tentzeris V, Lake B, Cherian T, et al. Poor awareness of symptoms of oesophageal cancer. Interactive Cardiovascular and Thoracic Surgery 2011; 12: 32-34.
8. Mitchell E, Macdonald S, Campbell NC, et al. Influences on pre-hospital delay in the diagnosis of colorectal cancer: a systematic review. British Journal of Cancer 2008; 98: 60-70.
9. Dobson CM, Russell AJ, Rubin GP. Patient delay in cancer diagnosis: what do we really mean and can we be more specific? BMC Health Serv Res 2014:14:387. Doi: 10.1186/1472-6963-14-387
10. Power E, Wardle J. Change in public awareness of symptoms and perceived barriers to seeing a doctor following Be Clear on Cancer campaigns in England. Brit J Cancer 2015;112:S22-S26. Doi 10.1038/bjc.2015.32.

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