Does mental health overshadow possible cancer symptoms: vignette survey with healthcare professionals
1
Epidemiology and Public Health, UCL, London, United Kingdom
2
Health and Communtity Sciences, University of Exeter, Exter, United Kingdom
3
Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
4
Centre for Cancer Screening, Prevention, Detection and Early Diagnosis, Queen Mary University of London, London, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
People with mental health conditions, such as anxiety and depression, can be at greater risk of diagnostic delays if experiencing cancer symptoms. This could be due to diagnostic overshadowing, when physical symptoms are attributed to a mental health comorbidity.
AIM:
To understand how information of anxiety and depression influences healthcare professionals’ attribution of symptoms and management decisions for potential bowel cancer. Design and setting: An online 2x2x3x3 mixed factorial design vignette survey was conducted with 242 primary care professionals.
METHODS:
Vignettes described a patient of varying sex, ethnicity, and mental health history, attending primary care for either rectal bleeding or change in bowel habits. After reading each vignette participants suggested and ranked potential causes of the symptoms, and selected management options. Logistic regression models were used to investigate associations.
RESULTS:
Symptoms were attributed to mental health more often when severe mental health conditions were reported (severe 4.7% vs no history 2.3%; OR=1.67). Severe mental health conditions did not change the likelihood of symptoms being attributed to bowel cancer (severe 12.5% vs no history 14.2%; OR=0.89) or selection of management options which influence diagnostic timeliness (OR=0.96). GPs compared to other healthcare professionals more often attributed symptoms to bowel cancer (OR=1.95) and requested FIT (OR=13.7).
CONCLUSIONS:
Symptoms were attributed to mental health more often for patients with severe mental health conditions. Further investigation is needed to determine whether management intentions are actioned in practice for patients with severe mental health history, as they may experience greater diagnostic delay and cancer inequalities.
People with mental health conditions, such as anxiety and depression, can be at greater risk of diagnostic delays if experiencing cancer symptoms. This could be due to diagnostic overshadowing, when physical symptoms are attributed to a mental health comorbidity.
AIM:
To understand how information of anxiety and depression influences healthcare professionals’ attribution of symptoms and management decisions for potential bowel cancer. Design and setting: An online 2x2x3x3 mixed factorial design vignette survey was conducted with 242 primary care professionals.
METHODS:
Vignettes described a patient of varying sex, ethnicity, and mental health history, attending primary care for either rectal bleeding or change in bowel habits. After reading each vignette participants suggested and ranked potential causes of the symptoms, and selected management options. Logistic regression models were used to investigate associations.
RESULTS:
Symptoms were attributed to mental health more often when severe mental health conditions were reported (severe 4.7% vs no history 2.3%; OR=1.67). Severe mental health conditions did not change the likelihood of symptoms being attributed to bowel cancer (severe 12.5% vs no history 14.2%; OR=0.89) or selection of management options which influence diagnostic timeliness (OR=0.96). GPs compared to other healthcare professionals more often attributed symptoms to bowel cancer (OR=1.95) and requested FIT (OR=13.7).
CONCLUSIONS:
Symptoms were attributed to mental health more often for patients with severe mental health conditions. Further investigation is needed to determine whether management intentions are actioned in practice for patients with severe mental health history, as they may experience greater diagnostic delay and cancer inequalities.
| eISSN: | 2654-1459 |
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