A comparative qualitative study of patients' experiences of cancer diagnosis in England, Denmark and Sweden

Talk Code: 

The problem

Survival rates for those with cancer in England are still poorer than in many European countries. Surveys suggest that this may be due to differences in how people recognise suspicious symptoms, report them to their doctors and how the doctors respond, and that these difference could lead to later diagnosis and a risk of later stage disease developing. Many factors that most significantly and adversely affect cancer survival - including delays in presentation and diagnosis - occur either before or soon after initial patient contact with the health system. Primary care is the first port of call for most people experiencing symptoms.

The approach

There is an established evidence base that shows that cross-country and cross-cultural comparisons can help us understand consultation and illness behaviour in response to symptoms. We are therefore conducting qualitative interviews with samples of recently diagnosed (less than six months) lung and colorectal patients in England, Denmark and Sweden. Researchers from each country are interviewing 60 patients (half with lung cancer and half with colorectal cancer), seeking a maximum variation sample of participants. Thematic analysis of the interviews using NVivo software is being used within each country to explore issues raised by participants (emergent themes) as well as those already known to researchers (anticipated themes). The findings from this initial analysis will then be brought together with those from the other countries so that comparisons could be made.


The study will provide new, in-depth insights into early stages of the care pathway from the patient's perspective and help to highlight opportunities for pathway and service redesign with the aim of promoting early identification and diagnosis. As part of the on-going iterative processes of qualitative analysis we propose to share some of our preliminary analysis with our audience.Consequence Qualitative studies can illuminate sequences, linkages, circumstances and factors preceding events and experiences, as well as their consequent effects. Such information is particularly important for service improvement, since problems are more likely to be addressed effectively if we understand why they happen. Therefore engaging the healthcare field is an important part of the qualitative analytical process, as it better allows for the recognition of important emerging themes that can then be developed and critically explored through further engagement with the data. Furthermore, the findings will help explain differences observed in the International Cancer Benchmarking Partnership (ICBP) and other quantitative studies.


  • John MacArtney, Aarhus University, Aarhus, Denmark
  • Sue Ziebland, Aarhus University, Aarhus, Denmark
  • Julie Evans, Aarhus University, Aarhus, Denmark
  • Alison Chapple, Aarhus University, Aarhus, Denmark
  • Louise Locock, Aarhus University, Aarhus, Denmark
  • Peter Vedsted, Karolinska University Hospital, Stockholm, Sweden
  • Rikke Andersen, Karolinska University Hospital, Stockholm, Sweden
  • Trine Nielsen, Karolinska University Hospital, Stockholm, Sweden
  • Carol Tishelman, Umeå University, Umeå, Sweden
  • Britt-Marie Bernhardson, Umeå University, Umeå, Sweden
  • Senada Hajdarevic, Lund University and Region Skåne, Lund, Sweden
  • Birgit Rasmussen
  • Marlene Malmström