Healthcare-seeking behavior and diagnostics in patients with colorectal cancer symptoms - implications of health literacy and national screening test

The purpose of this study is to create deep insight into the diagnostic process from the first experience of symptoms of colorectal cancer (CRC) to contact to the general practitioner (GP) and further investigations. We aim to analyze changes in the healthcare-seeking behavior between 2012 and 2022 and to analyze the barriers to help-seeking with symptoms of CRC. Analyses of the influence of health literacy, defined as the individuals’ ability to understand information about healthcare and to navigate in the healthcare system, will be a cornerstone in the analysis. Further, we examine the effects of the national screening program for CRC on healthcare-seeking behavior. With the introduction of the screening in 2014 a new way of examination emerged. It is well known that there is a social inequity in participation in the CRC screening, and that individuals with deprived socioeconomics are less likely to participate. Abdominal symptoms are frequent among screening-eligible individuals and compared to non-participants, screening-participants have higher diagnostic activity in general practice in the year preceding the screening. However, little is known about how CRC screening affects the individuals and the GPs’ behavior when the individual experiences CRC symptoms. It is possible that a negative screening test creates a false sense of security for both patients and GPs.

The study is based on data from two nationwide surveys in 2012 and 2022 comprising questions regarding symptom experiences, healthcare-seeking, and barriers to healthcare-seeking with CRC symptoms. The survey data will be supplemented with register data about socioeconomics, screening participation, and referral for further investigations with symptoms of CRC.

The results will increase the evidence base for identification and targeting of individuals at risk of postponing healthcare-seeking and for organizational interventions in primary care to promote timely diagnosis of CRC. It will reduce the social inequality in health in Denmark.